The Department for Work and Pensions (DWP) has issued an update on the medical evidence healthcare professionals may be asked to provide when someone claims Personal Independence Payment (PIP).
Updated guidance published this week explains how factual medical reports are used when deciding entitlement to disability and health-related benefits. The DWP said reports are not requested in every case, but may be sought where additional information is needed.
Evidence can come from the claimant, carers, relatives and friends as well as professionals involved in their care. It’s important to be aware that benefit decisions are made by non-medical decision makers, who can seek advice from healthcare professionals trained in disability assessment to interpret medical reports where necessary.
What a factual report may include
A factual report may be requested for someone claiming PIP where an assessment provider believes further evidence would help inform the advice it gives to the DWP. The department said a PIP assessment considers how someone's condition affects their ability to carry out a series of everyday activities.
These include preparing food, washing and bathing, dressing and undressing, communicating, reading, engaging with other people, making budgeting decisions, planning and following journeys and moving around.
Healthcare professionals completing a report can be asked to list all conditions or impairments affecting a patient's current functional ability and when they first presented. The DWP said details of someone's medical history can be particularly useful where they demonstrate how a condition has changed over time.
Information can also include whether a condition is considered mild, moderate or severe, whether it is well controlled and the results of relevant investigations or tests.
How fluctuating conditions are treated
The guidance makes clear that evidence about fluctuating conditions can be relevant to a PIP decision. Healthcare professionals are asked to provide information from the patient's clinical record covering both day-to-day and longer-term fluctuations, including the frequency and duration of exacerbations.
They may also be asked for relevant clinical findings showing the severity or impact of a person's conditions or impairments. Information about treatment can include medication and other treatment, aids and appliances, how frequently treatment is received and medication doses where relevant.
Where it is known, healthcare professionals can also provide factual information about how someone's condition affects their ability to carry out the everyday activities considered during a PIP assessment. The DWP stresses that it is looking for facts rather than opinion, although an opinion can be included where it is supported by factual evidence.
Examination not always required
The wider guidance also makes clear that a healthcare professional does not necessarily need to see a patient specifically to complete a factual medical report. The DWP tells professionals to complete reports as fully as possible using medical records and their existing knowledge of the patient, adding: “It is not necessary to interview or examine the patient in order to complete the report.”
For PIP factual reports, if the patient has not recently been seen by the person completing the form, the DWP asks for details of when and where they were last seen by another healthcare professional. The completed PIP factual report should be returned to the assessment provider within five working days of receipt.
The guidance also covers medical evidence used for Universal Credit, Employment and Support Allowance, Disability Living Allowance, Attendance Allowance and Industrial Injuries Disablement Benefit.
