It’s not ATOS any more of course, it’s Maximus AKA the Centre for Health and Disability Assessments AKA The Health Assessment Advisory Service
Info from Maximus about the Work Capability assessment https://www.chdauk.co.uk/assessment-process
limited capability for work = the WRAG = The Work Related Activity Group = Regulation 29. Descriptors and scoring system here
Limited capability for work-related activity = the Support Group = Regulation 35. Descriptors and scoring system here.
Medical examination – will you have to have one?
Nobody can be found not to have limited capability for work and refused ESA without first having a medical. But some people will be awarded ESA without having a medical.
If you have a serious condition and you clearly meet the criteria for limited capability for work and/or limited capability for work-related activity and there is medical evidence to support this then you may not have to have a medical. The medical evidence may be just a fit note (what used to be called a sick note) from your GP. Alternatively, the DWP may contact your GP or other health professional for a more detailed report, usually an ESA113 or a Factual Report which asks specific questions about your condition and how it affects you.
It is very definitely worth considering contacting your GP and any other health professionals involved in your care as soon as you make a claim for ESA. Update them about how your condition affects you, especially in relation to any activities in the physical health test that you think you may score points for.
If you can obtain supporting medical evidence and send copies (not originals) with your ESA50 questionnaire this can make a big difference to whether you have to have a medical.
Incapacity to ESA claimants
If you are being transferred from incapacity benefit to ESA then there is a real possibility you will be placed in either the work-related activity group (WRAG) or the support group without having a medical. This appears to happen to a much higher proportion of IB to ESA transfer claims than it does to ordinary ESA claims.
If you are placed in the WRAG and you are unhappy with this decision because you think you should be in the support group, then you may wish to consider an appeal. See our appeals guide for more about this.
Who carries out the medical
It may not be a doctor who carries out your medical. The law allows Maximus to use any registered health professional. So your assessment could be carried out by a nurse or an occupational therapist, for example. Many health professionals get paid per assessment by Maximus rather than getting a wage, so the faster they get through them the more they earn.
Preparing for a medical examination
We don’t want you to be overly concerned about having a medical examination. As we have explained elsewhere, many people with long-term health conditions are awarded ESA without having an examination at all. And even if you do have to have one, it is likely to last no more than half an hour to an hour and consist mostly of the doctor asking you questions about your everyday life.
Nevertheless, the doctor’s opinion will be taken very seriously by the decision maker, so it’s a good idea to be well prepared if you go for a medical.
Getting your appointment
If you are required to attend a medical you should receive at least 7 days notice unless you agreed to accept a shorter period of notice in writing or otherwise.
Maximus Healthcare generally try to arrange medicals by telephone and may leave messages warning you that your benefit may be affected if you do not return their calls. Alternatively they may write to you telling you that you must contact them within 48 hours to arrange an appointment.
If you are not able to use a telephone because of a mental health condition then insisting that you use one may be a breach of the Equality Act (formerly the Disability Discrimination Act).
If you wish to have someone with you then you will need to check with them whether they are available before agreeing to attend on the suggested date.
Do I have to attend the medical?
Yes you do. If you fail to turn up to the medical without good cause you will not be eligible for ESA. So, if you do miss the appointment, contact Maximus immediately, explain why and ask for another appointment. If this is refused and your benefit is stopped, try to get advice as quickly as possible from a welfare rights worker. You can appeal against the decision to find you capable of work.
Matters to be taken into account when deciding if you had good cause for not attending a medical include:
(a) whether you were outside Great Britain at the relevant time; (b) your state of health at the relevant time; and (c) the nature of any disability you have.
If you cannot attend the appointment because you are too ill to travel or have another appointment, such as a hospital visit which you cannot rearrange, then contact Maximus as soon as possible to rearrange the appointment. If you do this by telephone, make sure you get the name of the person you speak to and follow up your call with a letter confirming what was agreed.
Having a medical at home
If you are unable to attend a medical examination centre because of your health condition or disability, then you should be able to have a medical at home. However, you should be aware that a home medical will not be granted unless you can provide evidence that it is genuinely necessary. Medical evidence that you are unable to travel to an examination centre will make a big difference to the strength of your case.
If an assessment centre is not on the ground floor and you cannot use the stairs in the event of an emergency, they should look at an alternative venue or a home visit for you.
Below is the link to the list of assessment centres ATOS used – we believe Maximus (aka CHDA) are using the same ones. Find your centre and the spreadsheet will tell you whether the building’s got a lift and what floor the centre’s on, whether there’s parking, toilets etc and more. I’m glad I saved this to dropbox, they’ve taken the site down now.
Often they will send you to a centre miles away, rather than give you a home visit. The only sure way to get them to see you at your home is to ask your GP to fax Maximus and tell them you cannot attend at a centre and must have a home assessment. If you are unable to use stairs safely in an emergency, make sure you check whether the centre you are being sent to is on the ground floor as soon as you receive your appointment. If it isn’t, contact Maximus and ask them to make alternative arrangements.
WCA (assessments) helpline – Customer Relations Centre on 0800 288 8777 Email firstname.lastname@example.org
These are the same contact details as are given for your GP to use on this page: https://www.chdauk.co.uk/frequently-asked-questions-gps
Brian.email@example.com may be an email to the bloke that’s helped lots of us when he worked for Atos as the UK national Customer Service Manager. We do know he’s doing the same job for Maximus (or CHDA…)
Heres another email from the Maximus website – firstname.lastname@example.org
Preparing for questions
Before you attend the assessment, try to read through what you wrote on your questionnaire and have a look at any other evidence you have submitted. This might help to remind you of things you want to tell the doctor. In addition, it would be worth checking the section in this guide on questions you are likely to be asked at your medical examination.
Caution! Travelling to the medical
You can claim travelling expenses for going to the medical, but taxi fares won’t be paid unless this has been agreed beforehand with the DWP.
Give very careful consideration to how you travel to the medical, because you will be asked about how you did so and enormous assumptions may be made on the basis of your being able to drive or use public transport on your own, for example. It may be assumed that you can walk to and from bus stops without pain, that you can stand to wait for buses, rise from sitting to standing, handle coins, get up and down steps, sit for long periods and so on
If you do have to use public transport and it is painful or distressing for you, make sure you explain this to the doctor who assesses you.
Having someone with you
You are allowed to have someone come with you and sit in on your medical assessment. This can be anyone you like: friend, relative, carer, social worker, advice worker, etc. This may be particularly helpful if you are worried that you might be too fatigued or anxious to tell the doctor everything you think they should know. The doctor should give them the opportunity to provide information about you if that is what you want. But just having someone there may help you to feel more confident and to give more detailed information than you would be able to give if you were alone.
You or your accompanying person can also take notes at the medical. The doctor may read out a ‘Legal notice’ if you or your accompanying person are seen taking notes. This notice just tells you that your notes will not be regarded as part of the ‘official’ record of the medical and that you should not publish them elsewhere. However, there is nothing to stop you submitting your notes, or extracts from them, as part of any complaint or appeals procedure.
We always recommend that you take someone with you if you possibly can.
At the Assessment
I suggest that you assume that the assessor knows nothing at all about your condition and spell everything out in detail about how it affects you. A lot of the ways we manage to cope with every day life we take for granted but actually they are hurdles/barriers we overcome.
For example if you can manage to cook for yourself, but have to have special adaptations to enable you to manage this, then don’t just say yes if asked do you cook for yourself… make it clear what additional help you need (from gadgets or people), whether this takes you a long time or you tend to have accidents more than most, or whether you can only manage microwavable meals most of the time.
Try thinking about your every day living in terms of whether you manage your tasks as quickly/well/often as most people, so that you are prepared to explain your difficulties. Do not minimise your issues, even if there are things you find difficult to discuss.
Just say no
Think about what you will do if the health professional asks you to do something you feel unable to do. We would suggest that if the health professional asks you to do something that you know will cause you pain or severe discomfort you say that you can’t do it and explain why. If, however, you do something and it hurts, don’t suffer in silence. Tell the health professional you are in pain or they are likely to assume you have no problems with that activity.
And don’t put on a brave face and tell the doctor ‘I manage’ when they ask you about daily living activities. If you do that then they will have no choice but to assume you don’t score points. It’s important that you put aside your normal coping strategies and any desire to avoid appearing to feel sorry for yourself. The health professional can’t make an accurate assessment if you don’t tell them just how difficult your life is, and how miserable that sometimes makes you, no matter how hard that might be to admit.
Recording your medical
In the past, the DWP have made it virtually impossible for claimants to record their medical by insisting that they had to bring their own sound engineer and a dual tape-recording device with them.
However, the situation has changed since the beginning of February 2012. If you wish to have a recording of your medical made, so you can be sure that what you believe you said matches what the doctor reports, this should now be done for free for you by Maximus.
A dual recording machine is used by Maximus to produce two CD recordings of your medical, one of which is given to you at the end of your examination and the other is retained by Maximus.
Maximus have very few recording machines to cover the whole country, so your WCA is likely to have to be rescheduled and will probably be delayed by several weeks or more whilst a machine is booked and sent to your local centre.
What Maximus say about recording assessments:
We have written a standard letter to be used when you are given a date for your WCA. You can also make the request verbally if you are telephoned with an appointment, but you should still follow up with a letter. If possible send a copy both to the medical examination centre and to the DWP office dealing with your claim. See the next page:
Dear Sir/Ms, Name: National insurance number: WCA medical date: WCA medical venue: Re: having my assessment recorded
I wish to have my work capability face-to-face assessment recorded and I understand that this will be done by Maximus using dual recording facilities and at no cost to me, as has repeatedly been stated by the minister of state for employment, Chris Grayling. If recording facilities are not available on the date of my assessment, I wish to have it postponed until they are.
Right to a recording In a debate on the work capability assessment on 1 February 2012, Grayling told MPs that:
“On audio recording, we will offer everyone who wants it the opportunity to have their session recorded.” (Hansard citation: HC Deb, 1 February 2012, c291WH) http://www.publications.parliament.uk/pa/cm201212/cmhansrd/cm120201/halltext/120201h00 01.htm#12020157000270
On 17 July 2012, in reply to a written question by Frank Field MP, Grayling stated that:
“As part of this process we are also reviewing Maximus capacity to provide recordings for those claimants who currently request one. Additional machines have been ordered. However a large scale purchase of machines in the absence of an evaluation of the process is not effective use of public money. Although there have been increases in requests these still represent only a small percentage of overall work capability assessments.
“In the meantime, while Maximus will do all that they can to accommodate requests for audio recording there may be times when the service cannot be offered, for example where it has not be possible to get access to recording equipment on the date/time of the WCA. In these circumstances clients will be told in advance that their request cannot be accommodated and offered a later date.”
(Hansard citation: HC Deb, 17 July 2012, c783W)
If recording facilities are not available If recording facilities are not available on the date of my face- to-face assessment, I wish, to be offered a later date rather than be obliged to attend an assessment which is not recorded, as the minister has said is my right.
I understand, however, that on a number of recent occasions Maximus staff have claimed that following revised instructions from the DWP they will no longer cancel appointments if it transpires that recording equipment is not available, in spite of a proper request having been made.
Complaint to my MP I wish to make it clear that, should you seek to oblige me to attend an assessment without recording facilities I will immediately make a formal complaint to my MP and ask them to urgently ask the minister whether the statement he made to MPs on 12 July was truthful and, if so, why it is not being followed by the DWP and Maximus.
Right to written details of conditions If you seek to oblige me to attend a face-to-face assessment at which recording facilities are not available I wish to be provided with copies of any instructions or guidance issued by the DWP to Maximus as to when they are permitted to decline to meet a request for an assessment to be recorded.
In Upper Tribunal Case No. CIB/3117/2008, which concerned a claimant who refused to attend a medical unless he was permitted to record it, the upper tribunal judge held that:
“It has not been established that the appellant failed to show ‘good cause’ for failing to submit
himself for a medical examination on 22 October 2007.”
The tribunal judge went on to instruct that:
“The Secretary of State shall ask Medical Services to arrange for the appellant to be provided with details, in writing, of the conditions under which an interview or examination may be tape-recorded;
“The Secretary of State shall ask Medical Services to offer the appellant a further appointment for a medical examination.”
Should these written details not be provided to me I will seek legal advice as to whether I may have good cause to refuse to attend a medical. I shall also seek advice on whether I have grounds to seek compensation should I suffer financial hardship or emotional distress as a result of failure by the DWP or Maximus to follow their own proper procedures, legal rulings or ministerial undertakings.
Reasonable adjustments In some instances, such as where a claimant has difficulties with concentration caused by physical pain, fatigue or a mental health condition, it may be a reasonable adjustment under the Equality Act 2010 for the claimant to have the assessment recorded because they will be unable to take notes or properly recall what was said at the assessment.
Should you refuse to allow me to have my medical recorded I will seek legal advice as to whether I can take action against Maximus or the DWP for breach of the Equality Act. As a preliminary to that action I shall seek evidence of whether reasonable adjustments were considered in my case, such as inviting me to use my own recording device or postponing the assessment until a departmental device was available.
Appeal hearing Should I be unhappy with the decision in relation to my capacity for work I will appeal the decision and ask the tribunal to make a finding as to whether the failure of the DWP and Maximus to follow their own guidelines in relation to recording medicals should be taken into account when assessing the reliability of the Maximus medical report.
This letter is sent without prejudice as to any other legal remedies I may seek if I am refused the opportunity to have my assessment recorded.
Yours faithfully, Your name.
If you wish to give notice before you are asked to attend a WCA, for example by stapling a letter to your ESA50 then start like this instead:
Name: National insurance number:
Re: having my assessment recorded
If it is decided that I need to attend a face-to-face work capability assessment I hereby give notice that I wish to have the assessment recorded and to be provided with a copy of that recording.
I understand that this will be done by Maximus using dual recording facilities and at no cost to me … etc as above.
What happens at your LiMA computer controlled medical
Update 3rd March 2016
the software pages below now have a dialogue box for the assessor to put your information in directly as well as the tick box system, so if you see them typing a lot, it’s a good sign.
Almost all incapacity medicals are now carried out by an Maximus doctor or nurse using computer software called LiMA(Logic integrated Medical Assessment). The health professional is told by a computer screen what to ask you and spends a lot of the assessment answering multiple choice questions by clicking with a mouse.
Once the doctor or nurse has finished answering the questions, the computer generates a report selecting which descriptors it thinks should apply to you and pasting in what it considers to be evidence to support its choices.
The doctor or nurse is supposed to review the report before it is sent electronically to the DWP. It is possible for the doctor to disagree with the computer’s report and change it, but they must justify doing so and it’s always quicker just to go along with what the computer says. The health professional carrying out your medical is likely to be on piece work: they get paid per medical and the more medicals they carry out the more they earn. So there is a big incentive to get through each medical as quickly as possible.
Below is a screenshot from the 2003 version of the software used by Maximus health professionals.
The health professional has to choose one answer from each of the three sets of options. The computer will then construct a sentence such as:
‘Always likes to deal with own finances efficiently.’
Similarly, in the box on the next page, the doctor will choose options which will allow the computer to create a sentence such as:
‘Always likes to do housework for 2 hours’.
The computer will then paste these sentence repeatedly throughout the report to justify awarding or not awarding points for activities. For example, in relation to the ‘Learning how to do tasks’ activity, the computer may say that no points should be awarded because the claimant:
‘Always likes to deal with own finances efficiently.’ ‘Always likes to do housework for 2 hours’. In addition, in relation to the ‘Initiating actions’ activity, the computer may also say that no points
should be awarded because the claimant:
‘Always likes to deal with own finances efficiently.’ ‘Always likes to do housework for 2 hours’.
If the doctor or nurse considered that the claimant couldn’t do housework then he might use the dialogue box above to allow the computer to create a sentence such as:
‘Usually is unable to do housework due to apathy.’
The computer might then use this as justification for deciding that 9 points should be awarded for:
13(b) Cannot, due impaired mental function, reliably initiate or complete at least 2 sequential personal actions for the majority of the time.
It is possible for the health professional to type in their own evidence rather than using the multiple choice answers. However, if they do so the computer cannot copy and paste these answers into different bits of the report because it doesn’t have any way of understanding what the doctor has written. This means that the health professional will have to do the copying and pasting themselves which obviously takes more time and effort. The doctor or nurse may thus be reluctant to choose any option that is not already loaded into the software bearing in mind that, for people being paid per medical, time is money.
Questions you are likely to be asked at your medical
Below are a number of questions you are likely to be asked at your medical. Bear in mind that your answers may lead to further questions. For example, if you say that you use a computer you may be asked what you use it for, how often and how long for each time.
Some questions are more likely to be asked if you have a physical health problem. For example: ‘How many stairs do you have?’ and ‘Is the toilet upstairs or downstairs?’ Some are more likely to be asked if you have a mental health problem. For example: ‘Can you follow a simple recipe?’ and ‘Are you safe around electricity and gas?’
But most people are likely to be asked the majority of these questions. It’s worth looking through them and thinking about how you could most accurately answer them.
Travelling to the medical
Have you come on your own? How did you get here? Where do you live? How long did it take you to get here? Where have you parked? or Where did the bus stop? Did you have to walk (from the car park or bus stop)? How far was it?
Your health conditions
What are your main conditions? What medication do you take? Who do you see about your conditions? When did you last see them? Have you seen a specialist? Any hospital admissions in the last 12 months?
Do you live in a house or a flat? How many stairs do you have? Is the toilet upstairs or downstairs? Does anyone else live with you?
Who is this with you? Are you a friend or a relative? What is your name?
What was your last job? Why did you stop working? When did you stop working? Would you like to go back to work?
Sleeping, washing and dressing
What time do you go to bed? How do you sleep? What time do you wake up? Do you have problems getting out of bed or dressing? Does anybody help you?
Do you shower or bathe?
Cooking, housework and shopping
Do you do your own cooking? What kind of cooking do you do? Can you follow a simple recipe? Are you safe around electricity and gas? Have you had any accidents recently? Do you keep your home tidy? Do you do shopping? Do you go to the supermarket or the local shop? Do you walk or drive to the shops? How long do you shop for? How often do you go?
Hobbies and social life
What do you do all day? Do you have any hobbies or interests? Do you watch TV? What do you watch? Do you use a computer? Do you have friends? Do you have a social life? Do you like to spend time with friends or family? D you go to pubs or night clubs? Do you drink alcohol? Do you use any street drugs?
Do you have a pet? Do you feed your pet?
Do you have a telephone? Do you have problems with phone calls or doorbells? Do you phone your friends or family? Do you deal with you own letters and bills? Did you fill in the incapacity questionnaire yourself?
How is your temper? How is your mood? Do you have problems with anxiety or panic attacks? Did you get anxious or lose sleep thinking about coming here today?
More tips on Maximus WCA Assessments here