The Universal Credit Regulations 2013

Work Capability Assessment

When an assessment may be carried out

41.—(1) The Secretary of State may carry out an assessment under this Part where—

(a) it falls to be determined for the first time whether a claimant has limited capability for work or for work and work-related activity; or

(b) there has been a previous determination and the Secretary of State wishes to determine whether there has been a relevant change of circumstances in relation to the claimant’s physical or mental condition or whether that determination was made in ignorance of, or was based on a mistake as to, some material fact,

but subject to paragraphs (2) to (4).

(2) If the claimant has weekly earnings that are equal to or exceed the relevant threshold, the Secretary of State may not carry out an assessment under this Part unless—

(a) the claimant is entitled to attendance allowance, disability living allowance or personal independence payment; or

(b) the assessment is for the purposes of reviewing a previous determination that a claimant has limited capability for work or for work and work-related activity that was made on the basis of an assessment under this Part or under Part 4 or 5 of the ESA Regulations,

and, in a case where no assessment may be carried out by virtue of this paragraph, the claimant is to be treated as not having limited capability for work unless they are treated as having limited capability for work or for work and work-related activity by virtue of regulation 39(6) or 40(5).

(3) The relevant threshold for the purposes of paragraph (2) is the amount that a person would be paid at the hourly rate set out in regulation 11 of the National Minimum Wage Regulations 1999(1) for 16 hours a week.

(4) If it has previously been determined on the basis of an assessment under this Part or under Part 4 or 5 of the ESA Regulations that the claimant does not have limited capability for work, no further assessment is to be carried out unless there is evidence to suggest that—

(a) the determination was made in ignorance of, or was based on a mistake as to, some material fact; or

(b) there has been a relevant change of circumstances in relation to the claimant’s physical or mental condition.

Assessment - supplementary

42.—(1) The following provisions apply to an assessment under this Part.

(2) The claimant is to be assessed as if the claimant were fitted with or wearing any prosthesis with which the claimant is normally fitted or normally wears or, as the case may be, wearing or using any aid or appliance which is normally, or could reasonably be expected to be, worn or used.

(3) If a descriptor applies in the case of the claimant as a direct result of treatment provided by a registered medical practitioner for a specific disease, illness or disablement, it is to be treated as applying by reason of the disease, illness or disablement.

Information requirement

43.—(1) The information required to determine whether a claimant has limited capability for work or for work and work-related activity is—

(a) any information relating to the descriptors specified in Schedule 6 or 7 requested by the Secretary of State in the form of a questionnaire; and

(b) any additional information that may be requested by the Secretary of State.

(2) But where the Secretary of State is satisfied that there is enough information to make the determination without the information mentioned in paragraph (1)(a), that information is not required.

(3) Where a claimant fails without a good reason to comply with a request under paragraph (1), the claimant is to be treated as not having limited capability for work or, as the case may be, for work and work-related activity.

(4) But paragraph (3) does not apply unless the claimant was sent a further request to provide the information at least 3 weeks after the date of the first request and at least 1 week has passed since the further request was sent.

Medical examinations

44.—(1) Where it falls to be determined whether a claimant has limited capability for work or for work and work-related activity, the claimant may be called by or on behalf of a health care professional approved by the Secretary of State to attend a medical examination.

(2) Where a claimant who is called by or on behalf of such a health care professional to attend a medical examination fails without a good reason to attend or submit to the examination, the claimant is to be treated as not having limited capability for work or, as the case may be, for work and work-related activity.

(3) But paragraph (2) does not apply unless—

(a) notice of the date, time and place of the examination was given to the claimant at least 7 days in advance; or

(b) notice was given less than 7 days in advance and the claimant agreed to accept it.

(1)

S.I. 1999/584. Relevant amendments in S.I.2010/1901 and S.I. 2011/2345.