Archive for September, 2012

WCA repeat assessments and why they take place

If you receive Employment and Support Allowance (ESA) it is normal to be asked to attend a Work Capability Assessment (WCA) more than once.

When you first make a claim for ESA the DWP send a Work Capability Assessment referral to Atos Healthcare for advice on how your disability or illness affects your day to day life.

The DWP use this advice, and other information available to them, to make a decision on your claim.  If they decide to award you the Work Related Activity Component or Support Component for ESA they will also make a decision on when your circumstances need to be reviewed and will set a ‘re-referral date’ which will trigger the point at which you will be asked to attend for a new assessment.

The period for a re-referral date is usually between 3 months and 2 years after the date of the assessment.  It is sometimes referred to as a “prognosis” but it is important to note that it does not refer to any diagnosis of your condition.  Instead it is looking at a sensible time period to check if your limited capability for work is likely to change. Our health care professionals are asked to recommend to the DWP a “prognosis” date when they complete a WCA report for the DWP.

What happens when you are re-referred

Each time you are referred to us by DWP for a WCA you will be sent a “Limited Capability for Work Questionnaire”.  The DWP are likely to start this process and issue the questionnaire before the review period has ended.  This is because they are aiming to make a decision by the end of the review period and your assessment needs to have taken place ahead of that time.

When you are sent a new questionnaire to complete, you should provide the latest information on how you are affected by your disability or illness. It is especially important to give information about anything that has changed since you were last assessed. For example, has your condition improved, stayed the same, or worsened perhaps? Have you had any further treatment, or an operation, and has this helped? Have you now been diagnosed with a different condition? Please also provide as much relevant medical information as possible to explain how you are affected by your medical condition.  This will help the doctor or nurse reviewing your referral to identify if you need to attend a face-to-face assessment.

Repeat assessments after an appeal hearing

If you have appealed the decision made by DWP and their original decision has been changed, your case will be returned to a DWP Decision Maker who will review it and set the re-referral date.  The time period they choose will start from the original assessment date rather than the date of the appeal hearing.  This means in some cases that the re-referral date set can be quite soon after an appeal.  The DWP Decision Maker will have taken a number of factors into account including the details of your Limited Capability for Work (LCW) and factors the Tribunal took into account in reaching their decision of the re-referral date.

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The importance of additional medical information to the WCA process

The Department for Work and Pensions (DWP) decides when to send us a referral for a Work Capability Assessment.  When your case is referred, the DWP will write to you to advise you to expect a questionnaire and that this should be returned to Atos Healthcare after completion.

The questionnaire is called a “Limited Capability for Work Questionnaire”. The questionnaire is important, because it gives you the opportunity to detail the effects of your illness or disability on your everyday life.

You also have the opportunity to provide any extra medical information that may be relevant to your claim.  This may include some information you already have from a medical professional which describes how you are restricted by your medical condition. You can do this when you send in your questionnaire but there are also other opportunities to submit information before the DWP make their decision on your level of entitlement, if the information is not available before you need to return the questionnaire.

Atos Healthcare - providing Further Medical Evidence for WCA

Click on the image to enlarge

Sending extra information with your questionnaire

Atos Healthcare looks at the information in the questionnaire to help us to understand how your condition affects you on a day to day basis.  The DWP Decision Maker will also review it when making their decision.  If you have any additional medical information that you want to be considered please forward copies to us with the completed questionnaire in the envelope provided.  If we receive information with your questionnaire, we look at it initially to see if it may mean that you do not need to be called for a face to face assessment (See our blog post from the 30th August for more information on the review process).  The more information that you provide, the better the understanding we will have of how your conditions affect you.  If we do need to see you for a face to face assessment, we include the information in your file and the health care professional who sees you on the day will have read it before they come to meet you.

When we might contact your GP or specialist

Sometimes we may ask for extra medical information on your behalf.  Health care practitioners have the option to send specific questions to your GP or specialist based on the information that you provide. They will do this when they carry out an initial review of your questionnaire, where they believe that sufficient medical evidence may mean that you do not need to be seen face to face.

If we contact your GP or specialist to ask for information this is covered by their existing contract with the Department of Health, and so will not generate any kind of charge to you.

Bringing extra information to your assessment

If you are asked to attend a face to face assessment, you can also bring any medical information with you that you haven’t previously sent in.  If you bring it with you on the day, the HCP will look for items relevant to the assessment; this might not be everything, as the aim of the Work Capability Assessment is to look at the impact of your condition(s) on your daily life, rather than your diagnosis.  However, all of the medical evidence that you bring in will be copied and included in the file that is sent back to the DWP for their Decision Maker to use.  The HCP also continues to work on the report after you have left, and can review the information provided in more detail then.

When Atos Healthcare returns your referral to the DWP to help them make a decision on your benefit claim we also return any information you have submitted for the Decision Maker to consider.

Sending extra information after your assessment

When deciding on your level of entitlement, the DWP Decision Maker reviews all evidence, not just the report from Atos Healthcare.  If you get further medical information after your assessment has taken place – whether or not you have received a decision – you should contact DWP via the contact details you hold. You will have an opportunity to submit your evidence and have it considered as part of your claim.

See also:

Atos Healthcare consideration of evidence, before arranging an appointment for a Work Capability Assessment

How new additional medical information is used during a Work Capability Assessment

What should I bring to my Work Capability Assessment?

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Can I bring a companion to my Work Capability Assessment?

You are welcome to bring a relative, carer or friend to the assessment.  However, it is important to note that the assessment and discussion will always be focused towards you although we recognise that a companion may provide a valuable contribution. The health care professional will explain how they will proceed at the assessment.

If you need to bring children with you, please also bring someone to look after them while you are having your assessment.

If you are looking for any further information on the part of the Employment and Support Allowance (ESA) process and Work Capability Assessments, please visit our Frequently Asked Questions section.
If you have any questions you would like us to answer then do get in touch directly via the blog.

See also:

How to claim expenses for your ESA Work Capability Assessment

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