Update of Information on Welfare Benefits

In response to a query regarding GP reports to support benefit claims, we have spoken to the Benefits Agency in Newcastle and this is what they tell us.

Who Pays for the GP report?
The Benefits Agency pay for gathering medical evidence. A fixed annual budget is set by the agency. The Decision Maker will decide what is appropriate evidence to suit the individual claim – within the annual budget limits. Costs to the Benefits Agency for reports are:
Nothing for a Consultant Report
£17 for a GP report
£75 for an independent medical assessment
The decision makers tell us that in the vast majority of cases a visiting doctor will be arranged rather than a request for a report from your GP.

Who decides to request a report and what do they ask?
The decision maker decides whether or not to ask for GP report – depending on the claim. There is not a set list of questions specifically for ME – however there are three questions included under Chronic Fatigue Syndrome they will ask – they are:
1) What is the current treatment and what has been the response to treatment?
2) Please describe the nature of any mental health problems identified
3) Please describe and abnormal clinical findings giving details of any neurological impairment such as paralysis or muscle wasting

What happens if the claim is turned down?
If the claim is turned down you have the right to appeal. When you request an appeal all papers held by the decision maker are sent to both the customer and the appeals service. The appeals service then allocate an appeal date. Targets set nationally are 14 weeks from the notification of appeal - this is generally met. The customer is notified 14 days in advance of the hearing date.

What if your claim was turned down and a GP report was not included ?
When you receive all of the papers from the decision maker and a GP report was not requested - and you feel this would help your appeal - you can make a request for this from the decision maker. However the decision maker is not bound to agree to your request. You could request a report from your GP privately - the cost of this is variable and you will need to ask your practice. It is understood that it would be quite a bit more than the Benefit Agency cost. If you decide to get a GP report privately this must be sent to the decision maker who will accept it as an additional submission and send a copy to the chair of the appeals panel.

The Chair of the tribunal can ask for further medical evidence should they feel it necessary in advance of the appeal hearing.

Going through this process is painful and difficult for many. It is recommended that you seek help. Your local Welfare Rights Officer or CAB advisor can help you process your claims. If you have any questions give us a call - we will help if we can.