Incapacity Benefit (IB) is the main benefit paid to people who cannot work as a result of a health condition or disability.
The main test of entitlement to benefit is called the Personal Capability Assessment (PCA). Non-medical decision makers make decisions about entitlement taking all the evidence into account. This may include medical certificates, form IB113 and medical reports completed during face to face assessments by Atos Healthcare professionals.
The level at which the benefit threshold has been set has been designed to reflect the point at which a person’s ability to perform work related activities is substantially reduced, rather than the point at which work becomes impossible.
For people who are employed, the PCA is applied after 28 weeks of incapacity, in line with the completion of any Statutory Sick Pay they may have received. For people who are unemployed, the PCA is applied at the start of the period of incapacity.
People who are identified as having a severe health condition or disability on paper evidence are eligible for benefit without the need to undergo a face to face assessment. However, all others are required to undergo a face to face assessment. This assessment is carried out by approved Atos Healthcare professionals, who are trained in disability assessment. The assessment assesses a number of physical activities and the mental functioning of the patient.
The role of healthcare professionals
Healthcare professionals may be asked to provide medical information if it is considered possible that the person might meet the threshold of incapacity without the need for a face to face assessment. The information is usually requested by sending form IB113, or for specific questions, form FRR2.
Occasionally a healthcare professional from Atos Healthcare may phone you for more information. It is not necessary for you to discuss with your patient before releasing clinical information because they have already given their consent for this as part of the claim procedure.
Doctors are required to provide medical certificates until the start of the PCA. Under normal circumstances, GPs are not required to provide a medical certificate to the patient for the first 7 days of an illness. However, a medical certificate may be required from the first day of incapacity if the patient has made a previous claim to benefit in the recent past.