Medical Review


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THE MEDICAL REVIEW AND ASSESSMENT PROCESS

Introduction

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

Short-term Schemes

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.

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.

Long-Term Schemes:

When an application is made for a long-term scheme, supporting medical evidence may be submitted.

Disability Allowance:

In the case of Disability Allowance, a diagnostic medical report is completed by the applicant's medical practitioner. This is scanned by the Department and a Medical Assessor reviews the report form in line with evidence based medical protocols and Departmental guidelines and determines medical eligibility for the scheme.

Invalidity Pension:

In the case of Invalidity Pension, a diagnostic medical report is completed by the applicant's medical practitioner. This is scanned by the Department and a Medical Assessor reviews the medical report form in line with evidence based medical protocols and Departmental guidelines and determines medical eligibility for the scheme.

Dual Referral:

Dual referral is a process that came into being mid 2014.  Its purpose is to streamline the process of transferring the suitable customer who will be ending their two year Illness Benefit Scheme into Invalidity Pension, where this is appropriate and justified by medical evidence.
Customers will be selected based on the number of days on Illness Benefit, i.e. about 18 months into their Illness Benefit claim.  Two documents will be sent out to the customer: an MR99 and an MR33, the former should be filled out by the customer and the latter by their GP.  Based on the information returned, the Medical Assessor makes a desk assessment to determine whether the customer is eligible for Illness Benefit in the first instance.  If yes, then eligibility for Invalidity Pension is also considered.  This opinion will be used when they reach the end of two years on Illness Benefit.

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 Benefit Section refers the case to the Medical Review and Assessment Service. MRAS complete the assessment and return the file to Disablement Benefit Section as soon as possible.

Request for Assessment

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.

Assessment Centres

The Department uses Medical Review and Assessment Centres throughout the country including centres in Dublin and 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

Illness benefit and Injury Benefit Assessments are scheduled for approximately 15 minutes each. Illness Benefit and Injury Benefit Appeal assessments are scheduled for 20 minutes each. Disablement Benefit assessments are scheduled for 45 minutes and overseas and bilateral assessments are scheduled for 45 minutes or longer.

Notification to attend a Medical Assessment

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 medical report may be issued to the client in advance of an assessment.

Travelling Expenses

A client travelling further than 30 miles should make contact with the Medical Review and Assessment Service before travelling.

Who carries out the assessment

The assessments are carried out by one of a team of Medical Assessors employed by the Department. The Medical Assessors work under the overall control of the Department's Chief Medical Officer 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. All the Medical Assessors undertake assessments in the Medical Centres on a rota basis. A Nurse Attendant is also present at the assessment.

The Medical Assessment

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.

Illness Benefit

Results of Illness Benefit assessments fall into the following categories:-

Capable of Work: (not eligible)

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 this will be assessed by a different Medical Assessor who will determine if a second in-person assessment is required,  If the person is called for a second  in-person assessment they will be examined by a different Medical Assessor.

Incapable of Work: (Eligible)

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.

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 Officer 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 Officer arranges to have a form OB53 completed by the claimants doctor. The Chief Medical Officer 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.

Overseas Cases

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.

Failure to attend for assessment

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.

APPENDIX 1

LOCATION OF MEDICAL EXAMINATION CENTRES

 

Centre names and addresses
Centre Address
Arklow
DSP Intreo Office, Castle Park, Arklow
Athlone
DSP Intreo Office, Gracepark Road., Athlone
Ballina
DSP Intreo Office, Environment Office, Ballina
Ballinasloe
Social Welfare Office, Old Bank Chambers, Society Street, Ballinasloe
Bantry
Primary Care Centre, The Quay, Bantry
Birr
Health Centre, Johns Terrace, Birr
Buncrana
Inner Relief, Ardaravan, Buncrana
Cahirciveen
DSP Intreo Office, St. Brendans Terrace, Cahirciveen
Carlow
DSP Intreo Office, Government Offices, Kennedy Avenue, Carlow
Carrickmacross
Social Welfare Office, Martin's Premises, Ardee Road, Carrickmacross
Carrick-on-Shannon
Social Welfare Services Office, Shannon Lodge, Carrick-on-Shannon
Castlebar
DSP Intreo Office, Michael Davitt House, off Station Road, Castlebar
Cavan
DSP Intreo Office, Thomas Ashe Street, Cavan
Claremorris
Social Welfare Office, JamesStreet, Claremorris
Clifden
DSP Intreo Office, Galway Road, Clifden
Clonmel
Social Welfare Local Office, Neslon Street, Clonmel
Cork
Connolly Hall, Lapps Quay, Cork
Donegal
Public Service Centre, Drumlonagher, Donegal
Drogheda
DSP Intreo Office, Custom House Quay, Drogheda
Dublin
Oisin House, Pearse Street, Dublin 2
Dundalk
DSP Intreo Office, Government Buildings, St Alphonsus Road, Dundalk
Dungarvan
Civic Offices, Davitt's Quay, Dungarvan
Dungloe
DSP Intreo Office, Public Service Centre Gweedore Road, Dungloe
Ennis
DSP Intreo Office, Government Offices, Kilrush Road, Ennis
Enniscorthy
Slaney Medical Centre, Templeshannon, Enniscorthy
Fermoy
Connolly Street, Fermoy
Galway
DSP Intreo Office, Sean Duggan Centre, Fairgreen Road, Island House, Cathedral Square, Galway
Kenmare
The Medical Centre, Railway Road., Kenmare
Kilkenny
DSP Intreo Office, Government Buildings, Hebron Road, Kilkenny
Killarney
DSP Intreo Office, Park Court, Beech Road, Killarney
Letterkenny
Social Welfare Services Office, St Oliver Plunkett Road, Letterkenny
Limerick
23/27 Henry Street opposite the Red Church,
Limerick
Longford
DSP Intreo Office, Government Offices, Ballinalee Rd, Longford
Mullingar
DSP Intreo Office, Government Buildings, Belleview, Dublin Road, Mullingar
Navan
DSP Intreo Office, Kennedy House, Kennedy Road., Navan
Nenagh
DSP Intreo Office, Government Buildings, St Conleth's Road, Nenagh
Newbridge
DSP Intreo Office, Moorefield Road, Newbridge
Newcastlewest
Government Buildings, Gortboy, Newcastlewest
Portlaoise
Government Buildings, Abbeyleix Road, Portlaoise
Roscrea
Primary Care Centre, Templemore Road, Roscrea
Skibbereen
St Vincent de Paul Centre, Market Street, Skibbereen
Sligo
Social Welfare Services, College Road., Sligo
Thurles
Government Buildings, Stradovoher, Thurles
Tipperary
Government Buildings, Davis Street, Tipperary
Tullamore
Grand Canal House, Colmcille Road, Tullamore
Waterford
Government Offices, Cork Road, Waterford
Wexford
St. Bridgets Centre, Roches Road, Wexford
Wicklow
Government Offices, The Murrough, Wicklow
Last modified:09/09/2016
 

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