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:—

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;

• “the Contributions and Benefits Act” means the Social Security Contributions and Benefits Act 1992;

• “doctor” means a registered medical practitioner;

• “healthcare professional” means a person, not being the patient, who is—a registered medical practitioner;a registered nurse;a registered occupational therapist or registered physiotherapist;a registered pharmacist within the meaning ofarticle 3of thePharmacy Order 2010;

• “the Employment and Support Allowance Regulations” means the Employment and Support Allowance Regulations 2008;

• “limited capability for work” has the meaning—for the purposes of employment and support allowance, given in section 1(4) of the Welfare Reform Act 2007; andfor the purposes of universal credit, given in section 37 of the Welfare Reform Act 2012;

• “limited capability for work assessment” means the assessment of whether a person has limited capability for work—for the purposes of old style ESA, under Part 5 of the Employment and Support Allowance Regulations;for the purposes of new style ESA, under Part 4 of the Employment and Support Allowance Regulations 2013;for the purposes of universal credit, under Part 5 of the Universal Credit Regulations 2013;

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

• ...

• “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.

• (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.

Evidence of incapacity for work and confinement

2

• (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 healthcare professional in accordance with the rules set out in Part 1 of Schedule 1 to these Regulations.

• (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 who has not been assessed for the purposes of the personal capability assessment or 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 by means of a maternity certificate given by a doctor or by a registered midwife not 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.

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

3

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Transitional provisions and revocation

4

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SCHEDULE 1

PART I — RULES

1

In these rules, unless the context otherwise requires—

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

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

• ...

• “ other health professional ” means a person (other than a healthcare professional and not being the patient) who is..., a registered midwife, ... 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.

2

Where a healthcare 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 healthcare professional’s statement shall be in a form set out at Part 2 or Part 2A of this Schedule....

3

Where a healthcare professional issues a statement in any case other than in accordance with rule 2, the healthcare professional’s statement shall be in the form set out in Part 2 or Part 2A of this Schedule or in a form to like effect....

4

A healthcare professional’s statement must be based on an assessment made by that healthcare professional .

5

A healthcare professional’s statement... 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 healthcare professional’s statement is based;

• (c) the condition in respect of which the healthcare professional advises the patient they are not fit for work;

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

• (e) a statement that the healthcare 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 healthcare professional’s statement is given;

• (g) the address of the healthcare professional ; and

• (h) the name of the healthcare professional (whether in the form of a signature or otherwise); and

• (i) the profession of the healthcare professional

...

6

Subject to rule 8, the condition in respect of which the healthcare 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 healthcare professional’s knowledge of the patient’s condition at the time of the assessment permits.

7

Where a healthcare professional considers that a patient may be fit for work the healthcare 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.

8

The condition may be specified less precisely where, in the healthcare 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.

9

A healthcare 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 healthcare professional’s statement by way of replacement of an original which has been lost, in which case it shall be clearly marked “duplicate”.

10

Where, in the healthcare 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 healthcare professional’s statement is based, the healthcare professional’s statement shall specify that day.

11

Subject to rules 12 and 13, the healthcare professional’s statement shall specify the minimum period for which, in the healthcare 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.

12

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

Where

13

Where—

• (a) the patient has been advised by a healthcare 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 healthcare professional’s statement is based; and

• (b) in the healthcare professional’s opinion, the patient will not be fit for work for the foreseeable future,

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

14

The Notes set out in Part III of this Schedule shall accompany the form of doctor's statement provided by the Secretary of State.

15

A doctor may, having regard to the circumstances of the particular case, indicate on the doctor's statement that the claimant should be considered for vocational rehabilitation.

PART II — FORM OF DOCTOR'S STATEMENT

DOCTOR'S STATEMENT

PART III — THE NOTES

The following notes shall accompany the form of doctor's statement provided by the Secretary of State:—

On the doctor's statement:—

• (1) After the words “you should refrain from work for”, the period entered must not exceed 6 months unless the patient has, on the advice of a doctor, already refrained from work for a continuous period of 6 months.

• (2) After the words “you should refrain from work until”—

• (a) if the patient is being given a date when he can return to work the date entered should not be more than 2 weeks after the date of the examination;

• (b) if the patient has already been incapable of work for at least 6 months and recovery of capacity for work in the foreseeable future is not expected “further notice” may be entered.

SCHEDULE 2

PART I — rules

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 ...;

• (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) the 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.

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”.

PART II — FORM OF CERTIFICATE

MATERNITY CERTIFICATE

Please fill in this form in inkName of patient _________	Please fill in this form in inkName of patient _________
Part A	Part B
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 than 14 weeks before the expected week of confinement.	I certify that I attended you in connection with your confinement which took place on ......./........../........when you were delivered of a child (__ children).
I certify that I examined you on the date given below and in my opinion you can be expected to be confined in the week that includes ......./........../........
	Fill in the rest of Part B if the birth was before the expected week of confinement
Date of examination ......../........../........	In my opinion your confinement was expected in the week that includes ......./........../........
	Registered midwives
Date of signing ......./........../........	Please give your registered number or address here.
	_____
Signature:	_____
	_____
	Definitions"Confinement": The Social Security Act 1986 defines confinement as “labour resulting in the issue of a living child or labour after 28 weeks of pregnancy resulting in the issue of a child whether alive or dead”. Part B of the Maternity Certificate must not be used in any other circumstances,"Week": This means the 7 days beginning on a Sunday.
	Definitions"Confinement": The Social Security Act 1986 defines confinement as “labour resulting in the issue of a living child or labour after 28 weeks of pregnancy resulting in the issue of a child whether alive or dead”. Part B of the Maternity Certificate must not be used in any other circumstances,"Week": This means the 7 days beginning on a Sunday.

Signed

David Ennals — Secretary of State for Social Services — 1976-04-21

Explanatory note

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.