| Home
/ Hot Topics /Personal Capability Assessment
In April 1995, Incapacity Benefit replaced Invalidity Benefit
and Sickness Benefit for those people unable to work because of disease,
injury or impairment. Incapacity Benefit is paid to people who have the
correct National Insurance Contributions Record and who, because of a
specific physical or mental disease or disablement, could not be expected
to work, or seek work, in the open labour market as a condition of receiving
state benefit.
Payment of Incapacity Benefit does not signify that the person is medically
unable to do any work at all.
Incapacity Benefit introduced a new approach to the assessment
of medical incapacity (originally referred to as the All Work Test) which
from 4 April 2000 will be known as the Personal Capability Assessment
[PCA].
The basis of the medical test of incapacity was developed by a panel
of experts, whose key task was to establish a more objective test of incapacity,
taking into account medical factors only, and not other factors such as
age or skills.
The panel undertook research to identify a set of functional areas
relevant to the assessment of incapacity for work, and to develop within
each functional area a ranked scale of descriptors identifying
various levels of disability.
A sub-group of experts in the field of mental health problems developed
this area of the assessment, by identifying four areas of psychological
functioning which were important in the work situation, and developing
a series of questions, the answers to which would describe how a person
functioned in these four areas.
Entitlement to benefit is determined by Benefits Agency Decision Makers
who score the level of disability on the basis of the descriptors in the
physical and/or mental health areas, awarding benefit if the score reaches
or exceeds a set threshold level. Benefit can be awarded without need
for medical assessment if the Decision Maker is satisfied as to the level
of disability on the basis of available documentary evidence; but benefit
is never disallowed without the claimant being offered the opportunity
of medical assessment.
Where the Benefits Agency requests it, the Medical Services (IB approved)
doctor will be required to complete two reports on claimants summoned
for a Personal Capability Assessment examination - the Incapacity Report
which is the current IB85 report; and a Capability Report which will provide
advice to a Personal Adviser. The Capability Report will not be seen by
the Decision Maker.
All doctors who give advice relating to Incapacity Benefit are approved
by the Secretary of State. Approval involves specific training, successful
completion of various stages of an approval process, and the ongoing demonstration
that the work being carried out meets a satisfactory standard.
The IB approved doctor is required to provide advice to the BA Decision
Maker in accordance with the current guidance issued by the Department
of Social Security to help Decision Makers reach fair and proper decisions
on benefit entitlement.
Approved doctors provide advice which is:
- fair and impartial
- medically correct
- consistent and complete
- in accordance with the relevant legislation
In carrying out this function, IB approved doctors act as specialist
medical disability analysts. The role of the disability analyst
is different from the more familiar clinical role of reaching a diagnosis
and arranging treatment. For the disability analyst, a precise diagnosis
is of secondary importance. The primary function is to make an assessment
of how a person's day to day life is affected by disability, and to relate
this to the legislative requirements.
For Incapacity Benefit, the advisory role of the approved doctor falls
into three main areas:
- advising the Benefits Agency Decision Maker whether a claimant is
suffering from certain conditions that would make it unreasonable to
subject them to the Personal Capability Assessment (exempt conditions)
- scrutiny of medical evidence to advise whether a person to whom the
Personal Capability Assessment applies should be examined.
- application of the Personal Capability Assessment or Own Occupation
Test, providing an objective and impartial assessment of the claimant's
functional ability in the form of a report for the Decision Maker.
The training of approved doctors is therefore focused on the need for
objectivity and impartiality when assessing claimants and when providing
professional advice to decision makers.
The collection and recording of factual information is vital to the process
of assessment, as is the avoidance of speculation and opinion that cannot
be substantiated by the evidence.
The Personal Capability Assessment is applicable from the outset of a
spell of incapacity if the Own Occupation Test is inapplicable (because
a person has not worked in a job for at least eight weeks in the preceding
20 weeks). In all other cases the PCA is the relevant assessment from
the 29th week of incapacity.
The threshold set within the PCA, which determines the medical grounds
for benefit entitlement, is designed to reflect the point at which a person's
ability to perform physical and mental activities is substantially reduced
to a point where they should not be required to seek work as a condition
of benefit, rather than the point at which work becomes impossible.
People suffering from certain specified severely disabling conditions
will automatically be treated as incapable of work, without being tested
- the exempt categories.
People whose medical condition has resulted in the occurrence of certain
severely disabling effects may be treated as incapable of work without
having to undergo the PCA. The following categories are listed in the
Social Security (Incapacity for Work) (General) Regulations 1995 as amended
and can be determined by a Decision-Maker:
- people in receipt of the highest rate care component of Disability
Living Allowance
- people in receipt of an increase of disablement pension under section
104 of the Contributions and Benefits Act; a Constant Attendance Allowance
- people who are assessed at 80 per cent disabled for war pension,
industrial injury or Severe Disablement Allowance purposes
- people who are terminally ill, - defined as suffering from a progressive
disease and death in consequence of that disease can reasonably be expected
within six months
people suffering from the following severe medical conditions:
- tetraplegia
- paraplegia, or uncontrollable involuntary movements or ataxia
effectively render the sufferer functionally paraplegic
- persistent vegetative state
- dementia
- registered blindness
The PCA assesses a person's incapacity under 14 specified activities in
the area of physical and sensory function. The areas are:
walking
sitting
lifting and carrying
speech
continence
walking up and down stairs
rising from sitting
manual dexterity
vision
remaining conscious without having epileptic or similar seizures during
waking moments
standing
bending & kneeling
reaching
hearing
For each of these activities, there is a set of ranked statements, known
as descriptors, which illustrate different levels of functional limitation.
All cases where, on the evidence available, the claimant appears to have
a mental health problem will be referred to an approved doctor for advice,
before a questionnaire is issued. The approved doctor will identify those
claimants who have a severe mental health problem on the basis of factual
evidence supplied by the claimant's own doctor. Such people will be treated
as incapable of work.
A questionnaire is sent to the claimant who is asked to select those descriptors
which best describe any functional limitations they may have in each of
the physical and sensory areas listed.
Claimants are encouraged to provide any additional information which will
assist the Decision-Maker in applying the incapacity test.
Space is also provided on the questionnaire for the claimant to comment
on any health problems that affect their ability to perform work-related
activities.
An approved doctor will consider the questionnaire and any other evidence,
particularly the information provided by the certifying doctor in response
to a request for a Med 4 statement or IB113 report.
The approved doctor will advise the Decision Maker whether the functional
limitations reported by the claimant on the questionnaire are consistent
with the medical evidence. Where there is doubt about the stated level
of incapacity the claimant will be called for a medical examination.
The medical assessment process as a whole differs in many respects from
the traditional history taking and examination in the general practice
and hospital setting.
It entails bringing together information gained from the questionnaire,
any medical evidence and the examination in order to reach an accurate
assessment of the disability of a claimant for the Decision Maker re.
It is a complex procedure, involving careful consideration, structured
interviewing and lateral thinking, as well as the application of medical
skills.
A broad history is the initial step of the Personal Capability Assessment
medical examination, and the following structure is generally used:-
- A brief outline of the claimant's previous occupation and when and
why they left.
- A brief clinical history with details of hospital and other treatment
- Brief details of the claimant's domestic situation
- An outline of the claimant's problems and the functional limitations
imposed by them
- An outline of how a typical day may be spent
The nature of the examination is explained to the claimant because a general
examination is rarely performed. Instead the medical officer concentrates
on those systems that the claimant or their doctor state are responsible
for any disability.
As in normal clinical practice the examination commences with inspection.
When palpation is necessary the claimant is asked to indicate tender sites
to avoid undue discomfort.
Examination of the musculoskeletal system is performed in a consistent
and focussed manner to obtain an assessment of function. As far as possible
active movements are observed only to the point where the person indicates
the onset of discomfort.
Examination of other major systems follows standard clinical practice.
All claimants who are affected by a mental health incapacity will undergo
a mental health assessment in addition to any appropriate physical/sensory
assessment.
There are four specified activities which relate to capacity for work
in the assessment of the effects of mental health problems:
- daily living
- coping with pressure
- completion of tasks
- interaction with other people
For each of these activities there is a set of statements.
Unlike those for the assessment of physical and sensory functions, these
descriptors are not ranked on a rising scale of impairment. Instead, each
set of descriptors covers a range of different problems that may be encountered
within each activity.
The mental health descriptors are not part of the questionnaire that the
customer completes.
A person may qualify for benefit on the basis of limitation in mental
health functions, or on the basis of a combination of limitations in mental,
physical and/or sensory function.
There are a minority of conditions that do not lend themselves to a functional
assessment. In other words, the individual could carry out all the functions
in the test, but still be considered incapable of work. After carrying
out the functional assessment, an approved doctor will consider whether
there is evidence of the following:
- a severe life threatening disease which is uncontrolled or uncontrollable
by a recognised therapeutic procedure
- a previously undiagnosed life threatening condition
- if the claimant will, within three months of the date on which the
approved doctor examines him, have a major surgical operation or other
major therapeutic procedure.
In ascribing a particular level of functional limitation for a physical
activity, account is taken of any pain and fatigue as well as any fluctuation
of the medical condition and when choosing a descriptor in the mental
health assessment variability in level of function is addressed.
The aim of the test is not to judge whether a person can carry out a particular
action or function on a 'one-off' basis, but rather to assess the difficulties
a person encounters in carrying out the activities in a reasonably sustained
fashion over time.
Thus, the approved doctor's assessment is not simply be based upon a 'snapshot'
of the claimant's functional capacity at the time of the examination.
Your opinion on your patient's fitness for their usual occupation [usually
provided on statement Med 3] will apply during the first 28 weeks of incapacity
and is not considered as part of the PCA.
Once the Personal Capability Assessment applies Benefits Agency staff
with send those claimants not exempt from the test a questionnaire [IB50]
to complete and a request to obtain statement Med 4 from you.
When you issue a Med 4 it should contain details of:
- The diagnosis of the main incapacitating condition
- Other relevant medical conditions
And in the space for the doctor's remarks
- An indication of the disabling effects of the condition
- Current treatment and progress
- An indication of whether your patient would be unable to travel to
an examination centre and the reason for this opinion
It is in this final section of the Med 4 that you should record the advice
that you have given to your patient regarding their ability to perform
their usual occupation.
You may of course at this point advise your patient that they are now
fit to return to their regular employment.
The advice you provide on form Med 4 supersedes advice given on any earlier
statement, such as a Med 3.
At some point you may be asked to complete a factual report for a medical
officer, particularly where your patient is being considered for exemption
from the test or a medical examination.
The Benefits Agency will only request this information where the Agency
holds the appropriate informed consent of the patient.
You should complete the report as fully as you can - a seperate examination
of your patient is not required.
A fully completed report may:
- Avoid the need for your patient to undergo a benefit related examination
and
- Help the Benefits Agency Give your patient a prompt decision on their
entitlement
Further details regarding the provision of certificates and reports can
be found in 'A Guide for Medical Practitioners' the IB 204 at:
http://www.dwp.gov.uk/medical/medicalib204/index.htm
A booklet for patients 'A guide to Incapacity Benefit - The Personal
Capability Assessment' is available from Benefit Agency Offices.
All information on this site was correct at publication and is subject
to © Crown Copyright
|
