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re GPs charging or refusing to give medical evidence

Sun 28 Sep, 2014 4:25 pm

yahyah wrote:Reposting this courtesy of Taurus Cider on Cif who picked it up else where on the net.
[Someone on AOL so don't think any copyright issues]

If a claimant is in receipt of Employment and Support Allowance (ESA) and then they are subject to the Work Capability Assessment (WCA) which will invariably be the case, the burden of proof to show that a claimant is no longer entitled to the allowance rests fairly and squarely with the Department for Work and Pensions (DWP).

What this means in effect is that the DWP are obliged to seek evidence from a claimants GP and/or consultant which will insofar as communication with a GP is concerned, cost the DWP nothing as it is a contractual obligation to provide information free of charge.

The DWP/Atos are mandated to consider all the (medical) evidence, and not just that of the so-called approved disability analyst employed by Atos.

If the DWP fail to contact a claimant's GP/consultant, it can be argued if the case proceeds to an appeal that the DWP has not discharged its burden of proof in order to terminate ESA entitlement.

The DWP/Atos should never place a claimant at a financial disadvantage when they decide to review an ESA award, as the vast majority of claimants will not be in a position to pay for medical evidence especially if their ESA entitlement has been terminated.

If a claimant is subject to the WCA they should indicate on form ESA50 that it is the responsibility of the DWP/Atos to obtain further medical evidence and not a matter for the claimant, not least because a claimant will not be aware of precisely what evidence will be required, and they should never be charged for seeking medical evidence in order to support a review of ongoing entitlement initiated by the DWP

Re: re GPs charging or refusing to give medical evidence

Sun 28 Sep, 2014 4:25 pm

ephemerid wrote:That's not quite right.

It's only applicable to the WCA at the decision making stage - after the WCA, if the decision maker wants more information from the GP, they send the request to "Medical Services" (ie. Atos) who then send the forms to the GP.....and an invoice.

GPs are paid for any follow up to the WCA - I could describe why in detail if you want me to......

What the GPs are annoyed about is that having supplied certificates, then possibly (not always) an opinion on a pre-written questionnaire for which they are paid by Atos, they are now being asked by claimants to provide more help for appeals etc.

Once DWP have made their decision, if you are not happy with it, you can ask them to look at it again (currently, this is a reconsideration which is part of the appeals process) but they don't have to.
They invariably, in their arrogance, insist their decision is correct; and if you want a reconsideration you have to provide more evidence to support it; if they don't change the decision, you might need yet more for any appeal.
That evidence gathering is entirely the responsibility of the claimant.

DWP have an automated system and the longest period they can award ESA SG for is 2 years. In practice, this is very unusual and people are being reassessed this way again and again. (Me - 4 times in 3 years)
Every time the claimant "churns", the GP may be asked for more evidence, for which they get paid.
If the claimant asks after a duff decision, the GP does not get paid by Atos/DWP and that's what they're annoyed about.
They are being asked the same thing again and again, for the same person.

This is what they're asking for payment for, yahyah - my GP is part-time, and she's got 15 people who have asked several times in the past year for her to write letters for them. She doesn't ask for payment, but it eats into her time.

There is no legal requirement for DWP to cover costs of claimants who disagree with a decision; they only cover the cost via Atos for the first letter to assist with decision making.
There is no legal requirement for claimants not to be financially disadvantaged, either - in fact, new rules ensure that claimants who have the cheek to disagree with a decision WILL be disadvantaged.
From 1st,October, Clause 99 comes in (see ,y separate topic for the detail) and no benefit will be paid at all while the claimant waits indefinitely for Mandatory Consideration of Review. Even if it was agreed they should get WRAG, it will stop for the duration.
They can only get money if a decision maker agrees (and that takes forever)

Whatever the moral obligations of DWP, they have no legal ones. The WRA changed everything.

What you have described is not advice I'd give, personally; GPs are already paid for what is described. It's what happens afterwards and repeated that they're so pissed off about.

Re: re GPs charging or refusing to give medical evidence

Sun 28 Sep, 2014 4:25 pm

yahyah wrote:Thanks for the clarification Ephemerid.

It all really is a minefield.

Re: re GPs charging or refusing to give medical evidence

Sun 28 Sep, 2014 4:25 pm

ephemerid wrote:
yahyah wrote:Thanks for the clarification Ephemerid.

It all really is a minefield.


St.Steve of Walker and I are working on something about this at the mo.

Not GPs and their fees, so much as problems with Atos delays and Clause 99.

FTN will be first to see the results!
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