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Disability Living Allowance - medical examination

Some people who make a claim for DLA may be asked to have a medical examination. This is usually because more information about your disability or illness is needed before a decision on your claim can be made.

What is a medical examination?

A medical examination involves an interview and sometimes a medical examination with a healthcare professional (HCP) who has completed specialised training on disability and benefit awareness.

The medical examination is likely to be different from what you would expect from your own doctor. The HCP’s examination is not to diagnose or discuss treatment of your medical condition; it is to assess how your condition affects you and the HCP may not need to carry out a physical examination.

Who does what?

The people and organisations involved in the medical examination process are:

  • the Disability and Carers Service (DCS) – part of the Department for Social Development that handles benefit claims
  • Medical Support Services (MSS) – who organise medical examinations on behalf of DCS
  • the decision maker – a non-medical person within DCS who is responsible for making a decision on your benefit claim
  • the HCP – the HCP carries out the medical examination.

Why you’ve been asked for a medical examination

You may have been asked for a medical examination for several reasons. It doesn’t mean the information you’ve provided on your claim form is being treated as suspicious or that your claim will be turned down. One of the reasons for a medical examination may be to check you’re receiving the full amount of benefit you’re entitled to.

When you first apply for DLA, you are sent a claim form to complete. Your completed claim form is assessed by the decision maker, who must decide:

  • whether to approve your claim
  • whether you’re entitled to one or both of the benefit’s two components (the mobility component and the care component) and
  • how much benefit you’re entitled to receive

Decision Makers may ask for a medical examination if they need more information before they can make a decision, or they’re unsure about any details.

The Decision Maker can approve your claim without a medical examination if they’re happy with the information that they have obtained.

Special rules – if you are terminally ill

If you have a progressive disease and are not reasonably expected to live for more than another six months, there are special rules to help you get your benefit quickly and easily. It is very unlikely that you will have to attend a medical examination.

Medical examination when you’re already getting DLA

Receiving the right amount of benefit – Programme Protection Unit

If you’re already receiving DLA, you may be asked to have a medical examination as part of the Programme Protection Unit. Under the Programme Protection Unit, any DLA award may be reviewed to make sure the person is receiving the right amount of benefit.

If you receive an enquiry form, don’t worry, your current benefit award will only be changed if the review highlights a change in your current entitlement. If this happens, your award will be adjusted accordingly – this could be up or down. If there are no material changes, your award will remain the same as before.

Renewal claims and reviews

If you’ve been awarded DLA for a fixed period, you will have to make another claim to renew your benefit just before your entitlement ends. This is called a ‘renewal’ claim. Renewal claims are treated exactly the same as new claims, so you may be asked to have a medical examination.

If you have been awarded DLA for an indefinite period, you will not usually have to make a renewal claim. However, indefinite awards can sometimes be reviewed and you may need to have another medical examination as part of the review.

Your medical examination

The medical examination will usually take place in your own home (or where you live), or at a Medical Examination Centre near where you live. You should be given seven days’ notice of your examination but you can ask for an earlier appointment if this does not suit and MSS will try to rearrange it.

If you miss your first examination appointment, the HCP must make a second attempt to visit you. If you miss two appointments, or you refuse to attend, your benefit claim may be turned down.

You can:

  • have a friend, relative or support worker with you at the medical examination
  • ask for an interpreter if you need one
  • ask to be examined by a healthcare professional of the same gender as yourself

You need to let MSS know ahead of time if you want an interpreter or same gender HCP. They will try to find one for you, but this may not always be possible in some areas.