DWP reveal how it will decide not to                           carry out WCA reassessments.

The DWP has now published the final versions of the “severe conditions” healthcare professional (HCP) guidance and criteria, their training guide and case scenario’s.
 

The new DWP Severe Conditions Guidance says that: “The new re-referral period will apply to those with LCWRA ONLY. If a claimant has LCW but not LCWRA, the process remains as now.”

To avoid a reassessment, claimants will have to satisfy, all four of the following:

  1. The level of function will always meet LCWRA criteria;

  2. The condition will always be present (some lifelong conditions are present from birth, but others will develop or be acquired later in life);

  3. No realistic prospect of recovery of function (with advice on this being based on currently available treatment and not on the prospect of scientists discovering a cure in the future);

  4. Unambiguous condition (following all relevant clinical investigations a recognised medical diagnosis has been made).
     

If all the above four criteria and any of the LCWRA criteria are met, the HCP is to advise the decision maker that the claimant has a Severe Condition and has LCWRA.
 

Examples of conditions that might meet all four criteria are given as:

  • Motor Neurone Disease (MND);

  • severe and progressive forms of MS, Parkinson’s;

  • all dementias;

  • Huntington’s;

  • severe irreversible cardiorespiratory failure; and

  • severe acquired brain injury.
     

However, the guidance does makes clear that “this list is not exhaustive”.
 

In terms of making a no reassessment recommendation, the DWP says: “Where further evidence is considered necessary to enable advice regarding review or no review for a longer term prognosis further medical evidence review should always be chosen.
As per current process only one request for written medical evidence should normally be made and at review only one telephone attempt to chase the evidence is required. If the claimant or their representative needs to be contacted for further evidence then a maximum of two telephone calls should be made.
These should be documented on an FRR4. If the evidence is not available, you cannot advise that the claimant has a Severe Condition and normal filework case control action applies. Filework HCPs should not default to calling a claimant to an assessment if the evidence required to meet the criteria is not available.
If at filework a HCP feels that enough evidence is available on which a LCWRA ‘in the longer term’ recommendation can be made, but is unable to make a recommendation based on the Severe Conditions criteria, the advice is that they do not seek to call for exam but instead make a paper-based recommendation that change is not expected ‘in the longer-term’.

The reason being that DWP believes that to increase the burden on this group of claimants would be unnecessary and go against the spirit of the policy announcement.”

 

The principles behind the changes to reassessment criteria are to: