Medical Review
THE MEDICAL REVIEW AND ASSESSMENT PROCESS
Introduction
Cases referred for assessment
Short-term Schemes
Illness Benefit
Injury Benefit
Incapacity Supplement
Long-Term Schemes
Disability Allowance
Invalidity Pension
Disablement Benefit
Request for Assessment
Assessment Centres
Scheduling Assessments
Notification to attend a Medical Assessment
Medical Report Forms
Medical Report Form - MR2
Medical Report Form - MR33
Travelling Expenses
Who carries out the assessment
The Medical Assessment
Result of the Assessment
Illness Benefit
Capable of work
Incapable of work
Disability Allowance
Invalidity Pension
Disablement Benefit
Accidents
Diseases
Incapacity Supplement
Constant Attendance Allowance
Overseas Cases
UK Incapacity Claims
EU Cases
Bilateral Agreements
Failure to attend for assessment
Appendix 1: LOCATION OF MEDICAL ASSESSMENT CENTRES
The Medical Review and Assessment (MRA) system is the principal control mechanism for all illness and disability schemes administered by the Department. Medical Assessors carry out medical assessments, desk reviews and desk assessment of medical evidence/reports of customers in order to provide a second medical opinion for the guidance of Deciding and Appeals Officers.
Cases referred for assessment
Illness Benefit:
When a customer submits a first certificate for Illness Benefit (IB) a claim is registered on the Integrated Short Term Schemes (ISTS) computer system which records, among other items, the commencement date and the certified cause of incapacity.
The nature of the incapacity determines when the claimant is referred for referrals are determined by the Medical Assessor. initial medical assessment. Subsequent
Injury Benefit:
Payment of Injury Benefit (OIB) lasts for up to 26 weeks from the date of the accident/disease. The same referral process applies for OIB as for Illness Benefit - referral is based on the nature of the incapacity.
Incapacity Supplement:
To claim Incapacity Supplement a person must have been assessed as being a minimum of 20% disabled due to an accident at work and have no entitlement to Illness Benefit or another Social Welfare Benefit. A medical certificate is required monthly and cases are referred for assessment by Disablement Section in Government Buildings, Ballinalee Road, Longford. The client's details are entered on the medical report form by the Section in Longford and sent to MRA Section.
When an application is made for a long-term scheme, supporting medical evidence may be submitted.
Disability Allowance:
In the case of Disability Allowance (DA), the initial application requires the completion of a medical certificate by the persons General Practitioner (GP). A Medical Assessor carries out a desk assessment of the application to determine medical eligibility for DA. Cases are categorised as follows:
(A) Suitable for DA
(B) Unsuitable for DA
If further medical evidence is required to support the application then a form MR33 will be issued to the applicants GP for completion and return. The completed MR33 is returned to the Chief Medical Adviser and an opinion is given regarding suitability for the scheme.
If a medical assessment is required to assess eligibility the client's details are entered on the computer system by DA section and a request for medical assessment form (MR1) is generated in MRA Section and an appointment is arranged with one of the Department's Medical Assessors.
Invalidity Pension:
Applications for Invalidity Pension (INVP) from persons in receipt of IB are referred, by Illness Benefit Section, for medical assessment by a Medical Assessor to determine eligibility.
Applications for Invalidity Pension from customers not already in receipt of Illness Benefit are assessed by the Chief Medical Adviser to determine if a medical assessment is required. Where a medical assessment is required the client's details are entered on the computer system, by Invalidity Pension section, and a request for medical assessment form (MR1) is generated in MRA Section and an appointment is arranged with one of the Department's Medical Assessors.
Disablement Benefit:
All claimants for Disablement Benefit must be examined by a Medical Assessor to determine the degree of disablement. A Disablement Benefit claim can be reviewed on a continuing basis until the Medical Assessor gives a final opinion on the degree of disablement. When an assessment is required Disablement Section in Longford complete the claimant's personal details on the medical report form and refer same to MRA Section to arrange.
The referral/report form requesting a medical assessment will contain all the relevant details of a person's claim viz:
- Personal Public Service No.;
- Name and address;
- Sex;
- Date of birth;
- Certifier's name, address and panel number;
- Nature of incapacity;
- Date illness commenced;
- Result of last referral;
- Reason for current referral;
- Date of referral.
Medical papers from previous referrals are associated with the report forms, where relevant. The papers are then filed under the assessment centre nearest to the customer's address to await scheduling of assessments for that particular centre.
The Department uses Medical Review and Assessment Centres throughout the country including six centres in Dublin and three in Cork, which are in use on a full-time basis. The frequency of usage of the other centres will depend on the volume of cases on hand for assessment, the number requiring urgent attention (e.g. appeal cases) and the availability of the particular centre in any week. Appendix 1 lists the MR Centres.
Scheduling Assessments
Once the locations are decided, work commences on filling out the Medical Assessors appointment sheet for that day. Cases are selected for assessment on the basis of the following priority:
- Appeals against any suspension of payment;
- Appeals against suitability for other schemes;
- Urgent requests from scheme administrators;
- Bad attendance records at previous assessments;
- Applications for Long Term Illness Schemes;
- Applications for assessment of entitlement to Disablement Benefit;
- Review of a persons continued entitlement to payment.
Assessments are scheduled for 15 minutes each with the exception of Disablement Benefit and Overseas cases which are generally scheduled for 45 minutes (could be 1 hour in certain cases on the advice of the Chief Medical Adviser).
When a person is called for assessment a form issues notifying him/her of the date, time and place of the assessment, and of the travel arrangements.
In the case of Illness Benefit and Invalidity Pension (reviews and applications) a form may also be issued to the certifying doctor informing him/her of the forthcoming assessment and inviting him/her to supply the up to date details of the person's illness.
Where up- to- date reports are received in MRA Section they are associated with the person's medical papers and made available to the examining Medical Assessor.
Medical Report Forms
Medical Report Form - MR2
When a form MR2 issues to a person's General Practitioner (GP) it gives notice of the proposed medical assessment and invites the submission of further details in relation to the customer's medical condition. A Medical Assessor examines each report form to determine if the assessment should go ahead or if an opinion on medical eligibility can be given at that stage based on the information supplied.
Medical Report Form - MR33
A report form MR33 is issued to GPs prior to an assessment being arranged. All reports are examined by a Medical Assessor to decide if a medical assessment is appropriate at that time.
Travelling Expenses
A person residing at a distance of more than 2 miles from the assessment centre, other than in certain urban areas, is entitled to repayment of reasonable travelling expenses. A travel warrant and instructions on how to claim the refund are sent to the customer with the notification to attend for assessment. If there is no suitable public transport available a person may be authorised to use a taxi or hackney.
The assessments are carried out by one of the nineteen Medical Assessors employed by the Department. The Medical Assessors work under the overall control of the Department's Chief Medical Adviser and Deputy Chief Medical Adviser. The Medical Assessors are fully qualified doctors who have been specially trained to carry out medical reviews and assessments. Their role is to assess a person's fitness for work, either their usual work or in respect of other categories of work, and/or the degree of a person's disability. They do not prescribe treatment nor offer advice. A Nurse Attendant is also present at the assessment.
The geographical spread of the Medical Assessors is as follows:
- 10 in Dublin
- 3 in Cork
- 2 in Galway
- 1 in Kilkenny
- 2 in Longford.
- 1 in Donegal
All the Medical Assessors undertake assessments in the Medical Review and Assessment Centres on a rota basis.
The Medical Assessor carries out a medical assessment that is specially designed to determine a person's illness or disability. S/he examines the person to find out how their illness or disability affects the person in his/her everyday life or, if appropriate, whether or not s/he is fit for work, either their usual work or in respect of other categories of work.
The Medical Assessor considers all the information provided by the customer and the customer's own doctor. S/he may ask questions about the person's disability and carry out an assessment of the person's medical condition, which may include a physical examination. S/he records details on the medical report form during the course of the assessment. All assessments are carried out in accordance with the accepted guidelines of the Irish Medical Council.
The Medical Assessor's reports are returned to MRA Section at the end of each day.
Result of the Assessment
The Medical Assessor's report on the assessment is submitted to the Chief Medical Adviser for approval.
Illness Benefit
Results of Illness Benefit assessments fall into the following categories:-
Capable of Work:
If the Medical Assessor expresses the opinion that the customer is capable of work the opinion is sent to a Deciding Officer for decision. If the claim is disallowed, the customer is notified of that decision and of his/her right to appeal within twenty-one days. The client's certifier is also notified of the result of the assessment.
In the event of an appeal the person may be called for a second medical assessment and will be examined by a different Medical Assessor.
Incapable of work:
If the Medical Assessor expresses the opinion that the customer is incapable of work a new review date is set based on his/her opinion. The person's record is updated to trigger a referral for assessment at that date.
Disability Allowance:
The Medical Assessor will give an opinion on whether the person, by reason of a specified disability, may or may not be considered substantially handicapped in undertaking work of a kind which, if they were not suffering from that disability would be suited to their age, experience and qualifications.
This opinion is referred to the Deciding Officer for a decision on the claim (means criteria must also be satisfied for Disability Allowance).
In the case of a review assessment where the person does not satisfy the medical criteria, the payment is disallowed and the person is advised of his/her right of appeal.
Invalidity Pension
The Medical Assessor gives an opinion on whether the person can be considered permanently incapable of work and this opinion is relayed to the Deciding Officer for decision.
In the case of a review assessment, where the person does not satisfy the medical criteria for receipt of payment, the payment is disallowed and they are advised of their right of appeal.
Disablement Benefit
Accidents:
All Disablement Benefit claimants are examined by a Medical Assessor. The Assessor's report, which advises of the degree of disablement assessed, is submitted to the Chief Medical Adviser for approval in all cases before being referred to the Deciding Officer for decision.
The degree of disablement assessed may be provisional or final. In the case of provisional assessments the case is referred for further medical assessments until such time as a final assessment is made. The degree of disablement assessed determines whether a pension or gratuity is awarded.
Prescribed Diseases:
Please see SW 33.
Incapacity Supplement
The Medical Assessor will give an opinion on whether the person is, by reason of the occupational injury or disease, incapable of work for a period of six months. The opinion is referred to the Deciding Officer for decision.
Constant Attendance Allowance
The Medical Assessor will express an opinion as to whether or not the claimant requires constant attendance.
If so the Chief Medical Adviser arranges to have a form OB53 completed by the claimants doctor. The Chief Medical Adviser examines and advises regarding the possible level of Constant Attendance required. It is then referred to the Deciding Officer for decision. When making the decision the Deciding Officer will have regard to the degree of disablement, the severity of the incapacity and the level of attendance required.
UK Incapacity Claims:
The Medical Assessor carries out the medical assessment and completes a Medical Assessment Form provided by the UK authorities. However, the Medical Assessor does not express an opinion as to the person's fitness for work.
The completed UK Assessment Form is returned to the UK authorities where an adjudication officer determines the person's entitlements.
EU Cases:
The Medical Assessor examines the person and completes the medical report form (E213/214). S/he also expresses an opinion on the person's capacity for work. This opinion is relayed by the Department's EU Records Section to the relevant authorities in the EU country involved.
Bilateral Agreements:
The Department has a number of Bilateral Agreements with non-EU countries and is required, as part of these agreements, to carry out medical assessments on people resident in Ireland who are claiming benefits from another country. The Medical Assessor examines the person and completes the medical report form, which is supplied by the relevant country. The completed form is returned to the country of origin via the Department's International Records Section.
If a person fails to attend for assessment without showing good cause his/her entitlement to benefit may be affected. In the case of Illness Benefit the deciding officer may disallow payment for up to nine weeks. The customer is notified of the decision and is referred for further assessment. In the case of the long-term schemes, the relevant section in Longford is notified of the person's non-attendance and the medical papers are returned to the section. The relevant section in Longford writes to the person to establish the reason for non-attendance. If the person fails to contact the Department a deciding officer will disallow the payment and notify the person accordingly.
LOCATION OF MEDICAL EXAMINATION CENTRES
Centre names and addresses
|
Centre
|
Address
|
Phone Number
|
|
Arklow
|
Employment Exchange, Arklow
|
0402-32214
|
|
Athlone
|
Creggan Court Hotel, N6 Centre, Athlone
|
090-6477777
|
|
Ballina
|
New Government Buildings, Castle St, Ballina
|
096-60360
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|
Ballinasloe
|
SWI, Society St, Ballinasloe
|
090-9631810
|
|
Bantry
|
Health & Welfare Centre, Marino St, Bantry
|
027-50676
|
|
Belmullet
|
Social Welfare Local Office, America St, Belmullet
|
097-81029
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|
Birr
|
Health Centre, Johns Tce, Birr
|
0509-69750
|
|
Buncrana
|
Inishowen Gateway Hotel, Railway Road, Buncrana
|
074-9361144
|
|
Cahirciveen
|
Social Welfare Local Office, St Brendans Tce, Cahirciveen
|
066-9473444
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|
Carlow
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Government Offices, Kennedy Ave, Carlow
|
059-9141058
|
|
Carrickmacross
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SWI, Martin's Premises, Ardee Rd, Carrickmacross
|
042-9661896
|
|
Carrick-on-Shannon
|
Social Welfare Local Office, Leitrim Rd, Carrick-on-Shannon
|
071-9650070
|
|
Castlebar
|
Travellers Friend Hotel, Westport Rd, Castlebar
|
094-9023111
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|
Castleblayney
|
The Clinic, Castleblayney
|
042-9740462
|
|
Cavan
|
Newcourt Shopping Centre, Church St, Cavan
|
049-4361678
|
|
Claremorris
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SWI, James St, Claremorris
|
094-9372510
|
|
Clifden
|
Social Welfare Local Office, Galway Rd, Clifden
|
095-22210
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|
Clonmel
|
Government Offices, Neslon St, Clonmel
|
052-70220
|
|
Cork
|
Connolly Hall, Lapps Quay, Cork
|
021-4276251
|
|
Donegal
|
Public Service Centre, Drumlonagher, Donegal
|
074-9740070
|
|
Drogheda
|
Employment Exchange, Custom House Quay, Drogheda
|
041-9838626
|
|
Dublin
|
Oisin House, Pearse St, Dublin 2
|
01-6732078
|
|
Dundalk
|
Government Buildings, At Alphonsus Rd, Dundalk
|
042-9392757
|
|
Dungarvan
|
Civic Offices, Davitt's Quay, Dungarvan
|
058-20700
|
|
Dungloe
|
SWI, Public Service Centre Gweedore Rd, Dungloe
|
074-9561030
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|
Ennis
|
Government Offices, Kilrush Rd, Ennis
|
065-6829899
|
|
Enniscorthy
|
Slaney Medical Centre, Templeshannon, Enniscorthy
|
054-36663
|
|
Fermoy
|
Connolly St, Fermoy
|
025-31774
|
|
Galway
|
Island House, Cathedral Square, Galway
|
091-561377
|
|
Kenmare
|
Health Centre, Kenmare
|
064-42414
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|
Kilkenny
|
Government Buildings, Hebron Rd, Kilkenny
|
056-63086
|
|
Killarney
|
11 John Paul Pastrol Centre, Rock Rd, Killarney
|
064-32644
|
|
Kilrush
|
Kilrush Health Centre, Kilkee Rd, Kilrush
|
065-9051508
|
|
Letterkenny
|
SWI, St Oliver Plunkett Road, Letterkenny
|
074-9725566
|
|
Limerick
|
Employment Exchange, Dominick St, Limerick
|
061-414799
|
|
Listowel
|
The Clinic, Listowel
|
068-21222
|
|
Longford
|
Government Offices, Ballinalee Rd, Longford
|
044-48320
|
|
Mullingar
|
Employment Exchange, Blackhall St, Mullingar
|
044-48320
|
|
Naas
|
Block A, Maudlins Hall, Dublin Rd, Naas
|
045-901622
|
|
Navan
|
New Government Offices, Kells Rd, Navan
|
046-9077010
|
|
Nenagh
|
Government Buidlings, St Conleth's Rd, Nenagh
|
067-31660
|
|
Newcastlewest
|
Government Buidlings, Gortboy, Newcastlewest
|
069-62922
|
|
Portlaoise
|
Government Buidlings, Abbeyleix Rd, Portlaoise
|
057-8678020
|
|
Portumna
|
Health Centre, Portumna
|
0909-741193
|
|
Roscrea
|
The Dispensary, Gaol Rd, Roscrea
|
0505-21498
|
|
Skibbereen
|
St Vincent de Paul Centre, Market St, Skibbereen
|
028-21605
|
|
Sligo
|
New Government Buildings, Cranmore, Sligo
|
071-9148218
|
|
Thurles
|
Government Buidlings, Stradovoher, Thurles
|
0504-21736
|
|
Tipperary
|
Government Buidlings, Davis St, Tipperary
|
062-80052
|
|
Tralee
|
Shankill Resource Centre, Monavalley, Tralee
|
066-7127831
|
|
Tullamore
|
Government Buildings, Clonmich Rd, Tullamore
|
057-933623
|
|
Waterford
|
Government Buidlings, Cork Rd, Waterford
|
051-874177
|
|
Wexford
|
St Bridgets Centre, Roches Rd, Wexford
|
053-23819
|
|
Wicklow
|
Government Offices, The Murrough, Wicklow
|
0404-20407
|