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Medical Examinations

Failure to comply with requirements relating to attending for or participating in a medical examination can lead to loss of entitlement. Claimants may be able to show 'good reason' to avoid loss of entitlement.

Legislation

The rules for failure to attend for or participate in a medical examination are in regulations.

Regulation 9 of the main PIP Regulations provides -

(1) Where it falls to be determined whether [the claimant] has limited ability or severely limited ability to carry out daily living activities or mobility activities, [the claimant] may be required to do either or both of the following -

(a) attend for and participate in a consultation in person;

(b) participate in a consultation by telephone or by video.

(2) Subject to paragraph (3), where [the claimant] fails without good reason to attend for or participate in a consultation referred to in paragraph (1), a negative determination must be made.

(3) Paragraph (2) does not apply unless -

(a) written notice of the date, time and, where applicable, place for, the consultation is sent to [the claimant] at least 7 days in advance; or

(b) [the claimant] agrees, whether in writing or otherwise, to accept a shorter period of notice of those matters....

Regulation 10 of the main PIP Regulations provides -

The matters to be taken into account in determining whether [the claimant] has good reason under regulation … 9(2) include -

(a) [the claimant]’s state of health at the relevant time; and

(b) the nature of any disability that [the claimant] has.

Source: Part 2 of the Social Security (Personal Independence Payment) Regulations 2013 (SI.No.377/2013), and Part 2 of SR.No.217/2016 in Northern Ireland.

NB - in Scotland, adult disability payment is replacing personal independence payment - the Scottish Government has taken a different approach to assessments, as set out in sections 12, 13 and 14 of the Social Security (Scotland) Act 2018, by not using a private assessor and only requiring examinations if that is the only practicable way to get information - see also Consultations for Adult Disability Payment.

Case law

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