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The Social Security (Medical Evidence) Regulations 1976

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Statutory Instruments

1976 No. 615

SOCIAL SECURITY

The Social Security (Medical Evidence) Regulations 1976

Made

21st April 1976

Laid before Parliament

30th April 1976

Coming into Operation

4th October 1976

The Secretary of State for Social Services, in exercise of powers conferred upon him by section 115(1) of, and Schedule 13 to, the Social Security Act 1975 and of all other powers enabling him in that behalf, after reference to the National Insurance Advisory Committee, hereby makes the following regulations:—

Modifications etc. (not altering text)

Citation, commencement and interpretation

1.—(1) These regulations may be cited as the Social Security (Medical Evidence) Regulations 1976, and shall come into operation on 4th October 1976.

(2) In these regulations, unless the context otherwise requires—

“the Act” means the Social Security Act 1975;

[F1“the Contributions and Benefits Act” means the Social Security Contributions and Benefits Act 1992;]

“doctor” means a registered medical practitioner;

[F2“healthcare professional” means a person, not being the patient, who is—

(a)

a registered medical practitioner;

(b)

a registered nurse;

(c)

a registered occupational therapist or registered physiotherapist;

(d)

a registered pharmacist within the meaning of article 3 of the Pharmacy Order 2010;]

[F3“the Employment and Support Allowance Regulations” means the Employment and Support Allowance Regulations 2008;]

[F4“limited capability for work” has the meaning—

(a)

for the purposes of employment and support allowance, given in section 1(4) of the Welfare Reform Act 2007; and

(b)

for the purposes of universal credit, given in section 37 of the Welfare Reform Act 2012;]

[F5“limited capability for work assessment” means the assessment of whether a person has limited capability for work—

(a)

for the purposes of old style ESA, under Part 5 of the Employment and Support Allowance Regulations;

(b)

for the purposes of new style ESA, under Part 4 of the Employment and Support Allowance Regulations 2013;

(c)

for the purposes of universal credit, under Part 5 of the Universal Credit Regulations 2013;]

[F6“personal capability assessment” means the assessment provided for in section 171C of the Contributions and Benefits Act;]

F7...

[F8“registered midwife” means a midwife who is registered as a midwife with the Nursing and Midwifery Council under the Nursing and Midwifery Order 2001;]

“signature” means, in relation to any statement or certificate given in accordance with these regulations, the name by which the person giving that statement or certificate, as the case may be, is usually known (any name other than the surname being either in full or otherwise indicated) written by that person in his own handwriting; and “signed” shall be construed accordingly.

(3) Any reference in these regulations to any provisions made by or contained in any enactment or instrument shall, except in so far as the context otherwise requires, be construed as a reference to that provision as amended or extended by any enactment or instrument and as including a reference to any provision which it re-enacts or replaces, or which may re-enact or replace it, with or without modification.

(4) The rules for the construction of Acts of Parliament contained in the Interpretation Act 1889 shall apply in relation to this instrument and in relation to the revocation effected by it as if this instrument, the regulations revoked by it and regulations revoked by the regulations so revoked were Acts of Parliament, and as if each revocation were a repeal.

[F9(5) For the purposes of the definition of “limited capability for work assessment” in paragraph (2)—

(a)“old style ESA” means an allowance under Part 1 of the Welfare Reform Act 2007 as that Part has effect apart from the amendments made by Schedule 3, and Part 1 of Schedule 14, to the Welfare Reform Act 2012 that remove references to an income-related allowance; and

(b)“new style ESA” means an allowance under Part 1 of the Welfare Reform Act 2007 as amended by the provisions of Schedule 3, and Part 1 of Schedule 14, to the Welfare Reform Act 2012 that remove references to an income-related allowance.]

Textual Amendments

Evidence of incapacity for work[F10, limited capability for work] and confinement

2.—[F11(1) Subject to regulation 5 and paragraph (1A) below, where a person claims to be entitled to any benefit, allowance or advantage (other than industrial injuries benefit or statutory sick pay) and entitlement to that benefit, allowance or advantage depends on that person being incapable of work or having limited capability for work, then in respect of each day until that person has been assessed for the purposes of the personal capability assessment or the limited capability for work assessment they shall provide evidence of such incapacity or limited capability by means of a statement given by a [F12healthcare professional] in accordance with the rules set out in Part 1 of Schedule 1 to these Regulations.]

[F11(1A) Where it would be unreasonable to require a person to provide a statement in accordance with paragraph (1) above that person shall provide such other evidence as may be sufficient to show that they are incapable of work or have limited capability for work so that they should refrain (or should have refrained) from work by reason of some specific disease or bodily or mental disability.]

(2) Every person to whom paragraph (1) applies [F13who has not been assessed for the purposes of the [F14personal capability assessment]] [F15or the limited capability for work assessment] shall, before he returns to work, furnish evidence of the date on which he will become fit to resume work either in accordance with rule 10 of Part I of Schedule 1 to these regulations, or by such other means as may be sufficient in the circumstances of the case.

(3) Every woman who claims maternity benefit shall furnish evidence—

(a)where the claim is made in respect of expectation of confinement, that she is pregnant and as to the stage which she has reached in her pregnancy; or

(b)where the claim is made by virtue of the fact of confinement, that she has been confined,

and shall furnish such evidence [F16by means of a maternity certificate] given by a doctor or by a [F16registered midwife] [F17not earlier than the beginning of the 20th week before the week in which she is expected to be confined,] in accordance with the rules set out in Part I of Schedule 2 to these regulations in the appropriate form as set out in Part II of that Schedule or by such other means as may be sufficient in the circumstances of any particular case.

Textual Amendments

Amendment of the Social Security (Claims and Payments) Regulations 1975

F183.  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Textual Amendments

Transitional provisions and revocation

F194.  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Textual Amendments

[F20Self-certificate for first 7 days of a spell of incapacity for work [F21or limited capability for work]

5.—[F22(1) [F23The evidence of incapacity [F24or limited capability for work] required for the purposes of determining entitlement to a benefit, allowance or advantage referred to in regulation 2(1)]–

(a)for a spell of incapacity which lasts less than 8 days, F25...

(b)in respect of any of the first 7 days of a longer spell of incapacity;

[F26(c)for a period of limited capability for work which lasts less than 8 days; or]

[F26(d)in respect of any of the first 7 days of a longer period of limited capability for work,]

  • may consist of a self certificate instead of a certificate in the form of a statement in writing given by a [F27healthcare professional] in accordance with regulation 2(1).]

(2) For the purpose of this regulation-

  • [F28“self-certificate” means either—

    (i)

    a declaration made by the claimant in writing, on a form approved for the purpose by the Secretary of State; or

    (ii)

    where the claimant has made a claim for employment and support allowance in accordance with regulation 4G of the Social Security (Claims and Payments) Regulations 1987, an oral declaration by the claimant,

    that the claimant has been unfit for work from a date or for a period specified in the declaration and may include a statement that the claimant expects to continue to be unfit for work on days subsequent to the date on which it is made;.]

  • [F29“spell of incapacity” has the meaning given to it by section 171B(3) of the Contributions and Benefits Act.]]

Textual Amendments

David Ennals

Secretary of State for Social Services

Regulation 2(1)

[F30SCHEDULE 1

Textual Amendments

PART 1RULES

1.  In these rules, unless the context otherwise requires—

“assessment” means either a consultation between a patient and a [F31healthcare professional] which takes place in person or by telephone or a consideration by a [F31healthcare professional] of a written report by another [F31healthcare professional] or other health F32...professional;

“condition” means a specific disease or bodily or mental disability;

F33...

“ [F34other health professional] ” means a person (other than a [F35healthcare professional] and not being the patient) who isF36..., a registered midwife, F37... or a member of any profession regulated by a body mentioned in section 25(3) of the National Health Service Reform and Health Care Professions Act 2002;

“patient” means the person in respect of whom a statement is given in accordance with these rules.

Textual Amendments

2.  Where a [F38healthcare professional] issues a statement to a patient in accordance with an obligation arising under a contract, agreement or arrangement under Part 4 of the National Health Service Act 2006 or Part 4 of the National Health Service (Wales) Act 2006 or Part 1 of the National Health Service (Scotland) Act 1978 the [F39healthcare professional’s] statement shall be in a form set out at Part 2 [F40or Part 2A] of this ScheduleF41....

Textual Amendments

3.  Where a [F42healthcare professional] issues a statement in any case other than in accordance with rule 2, the [F43healthcare professional’s] statement shall be in the form set out in Part 2 [F44or Part 2A] of this Schedule or in a form to like effectF45....

Textual Amendments

4.  A [F46healthcare professional’s] statement must be based on an assessment made by that [F47healthcare professional] .

Textual Amendments

5.  A [F48healthcare professional’s] statementF49... shall contain the following particulars—

(a)the patient’s name;

(b)the date of the assessment (whether by consultation or consideration of a report as the case may be) on which the [F48healthcare professional’s] statement is based;

(c)the condition in respect of which the [F50healthcare professional] advises the patient they are not fit for work;

(d)a statement, where the [F50healthcare professional] considers it appropriate, that the patient may be fit for work;

(e)a statement that the [F50healthcare professional] will or, as the case may be will not, need to assess the patient’s fitness for work again;

(f)the date on which the [F48healthcare professional’s] statement is given;

(g)the address of the [F50healthcare professional] [F51;] [F52and]

(h)[F53the name of the [F50healthcare professional] (whether in the form of a signature or [F54otherwise); and]]

[F55(i)the profession of the healthcare professional]

F56...

Textual Amendments

[F575A.  Where the healthcare professional’s statement is in the form set out in Part 2 of this Schedule—

(a)the healthcare professional’s name shall, irrespective of their profession, be recorded next to the words “doctor’s signature”;

(b)the healthcare professional’s address shall, irrespective of their profession, be recorded next to the words “doctor’s address”; and

(c)the healthcare professional shall record their profession within the statement in such place as appears to them to be appropriate.]

Textual Amendments

6.  Subject to rule 8, the condition in respect of which the [F58healthcare professional] is advising the patient is not fit for work or, as the case may be, which has caused the patient’s absence from work shall be specified as precisely as the [F59healthcare professional’s] knowledge of the patient’s condition at the time of the assessment permits.

Textual Amendments

7.  Where a [F60healthcare professional] considers that a patient may be fit for work the [F60healthcare professional] shall state the reasons for that advice and where this is considered appropriate, the arrangements which the patient might make, with their employer’s agreement, to return to work.

Textual Amendments

8.  The condition may be specified less precisely where, in the [F61healthcare professional’s] opinion, disclosure of the precise condition would be prejudicial to the patient’s well-being, or to the patient’s position with their employer.

Textual Amendments

9.  A [F62healthcare professional’s] statement may be given on a date after the date of the assessment on which it is based, however no further statement shall be furnished in respect of that assessment other than a [F62healthcare professional’s] statement by way of replacement of an original which has been lost, in which case it shall be clearly marked “duplicate”.

Textual Amendments

10.  Where, in the [F63healthcare professional’s] opinion, the patient will become fit for work on a day not later than 14 days after the date of the assessment on which the [F63healthcare professional’s] statement is based, the [F63healthcare professional’s] statement shall specify that day.

Textual Amendments

11.  Subject to rules 12 and 13, the [F64healthcare professional’s] statement shall specify the minimum period for which, in the [F64healthcare professional’s] opinion, the patient will not be fit for work or, as the case may be, for which they may be fit for work.

Textual Amendments

12.  The period specified shall begin on the date of the assessment on which the [F65healthcare professional’s] statement is based and shall not exceed 3 months unless the patient has, on the advice of a [F66healthcare professional] , refrained from work for at least 6 months immediately preceding that date.

Textual Amendments

13.  Where—

(a)the patient has been advised by a [F67healthcare professional] that they are not fit for work and, in consequence, has refrained from work for at least 6 months immediately preceding the date of the assessment on which the [F68healthcare professional’s] statement is based; and

(b)in the [F68healthcare professional’s] opinion, the patient will not be fit for work for the foreseeable future,

instead of specifying a period, the [F67healthcare professional] may, having regard to the circumstances of the particular case, enter, after the words “case for”, the words “an indefinite period”.

Textual Amendments

PART 2FORM OF [F69healthcare professional’s] STATEMENT]

Textual Amendments

[F70PART 2AALTERNATIVE FORM OF [F71healthcare professional’s] STATEMENT

Textual Amendments

 ]

Regulation 2(1)

F72SCHEDULE 1A

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Textual Amendments

Regulation 2(1)(c)

F73SCHEDULE 1B

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Textual Amendments

Regulation 2(3)

[F74SCHEDULE 2

Textual Amendments

PART Irules

1.  In these rules any reference to a woman is a reference to the woman in respect of whom a maternity certificate is given in accordance with these rules.

2.  A maternity certificate shall be given by a doctor or registered midwife attending the woman and shall not be given by the woman herself.

3.  The maternity certificate shall be on a form provided by the Secretary of State for the purpose and the wording shall be that set out in the appropriate part of the form specified in Part II of this Schedule.

4.  Every maternity certificate shall be completed in ink or other indelible substance and shall contain the following particulars—

(a)the woman’s name;

(b)the week in which the woman is expected to be confined or, if the maternity certificate is given after confinement, the date of that confinement and the date the confinement was expected to take place F75...;

(c)the date of the examination on which the maternity certificate is based;

(d)the date on which the maternity certificate is signed; and

(e)[F76the address of the doctor or, where the maternity certificate is signed by a registered midwife, the personal identification number given to her by the Nursing and Midwifery Council (“NMC”) on her registration in the register maintained under article 5 of the Nursing and Midwifery Order 2001 and the expiry date of that registration]

and shall bear opposite the word “Signature”, the signature of the person giving the maternity certificate written after there has been entered on the maternity certificate the woman’s name and the expected date or, as the case may be, the date of the confinement.

Textual Amendments

F75Words in Sch. 2 Pt. I para. 4(b) omitted (1.11.1991) by virtue of The Social Security (Miscellaneous Provisions) Amendment Regulations 1991 (S.I. 1991/2284), regs. 1, 21(a)

5.  After a maternity certificate has been given, no further maternity certificate based on the same examination shall be furnished other than a maternity certificate by way of replacement of an original which has been lost or mislaid, in which case it shall be clearly marked “duplicate”.

[F77PART IIFORM OF CERTIFICATE

Textual Amendments

MATERNITY CERTIFICATE

Please fill in this form in ink

Name of patient _________________________________

Fill in this part if you are giving the certificate before the confinement.

Fill in this part if you are giving the certificate after the confinement.
Do not fill this in more [F78than 20 weeks] before the week the baby is expected.I certify that I attended you in connection with the birth which took place on ......./........../....... when you were delivered of a child [__] children.
I certify that I examined you on the date given below. In my opinion you can expect to have your baby in the week that includes ......./........../........In my opinion your baby was expected in the week that includes ......./........../........

"Week": This means the 7 days beginning on a Sunday.

Date of examination ......../........../........Registered midwives:
Please give your [F79NMC] Personal Identification Number and the expiry date of your registration with the [F79NMC].
Date of signing ......./........../........___________________________________
Signature:

Doctors:

Please stamp your name and address here [F80(unless the form has been stamped, in Wales, by the Local Health Board in whose medical performers list you are included or, in Scotland,] F81[F82 by the Health Board in whose primary medical performers list you are included)]]]

Textual Amendments

EXPLANATORY NOTE

The Regulations provide for the manner in which evidence of incapacity for work or of expected confinement or confinement is to be given for the purposes of a claim for benefit under the Social Security Act 1975 for which evidence is required. The Regulations replace the Social Security (Medical Certification) Regulations 1975 (“the 1975 Regulations”) which are revoked.

The Regulations and Rules in Schedule 1 prescribe a certificate in the form of a doctor's statement in which the issuing doctor advises the claimant that he need not refrain from work or, as the case may be, that he should refrain from work for a period of up to 6 months, or longer in certain circumstances. Certificates for the purposes of maternity benefit are prescribed in Schedule 2 and correspond to those in the 1975 Regulations. The Regulations amend the Social Security (Claims and Payments) Regulations 1975 so that a doctor's statement and a special statement based on a written report from another doctor may be accepted for the purposes of forward allowances of certain benefits.

The Report of the National Insurance Advisory Committee dated 10th March 1976 on the draft of these Regulations referred to them is contained in House of Commons Paper No. 349 (Session 1975–76) published by Her Majesty's Stationery Office.

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