This booklet contains guidelines and instructions concerning medical certification for doctors who have been approved as Medical Certifiers under Social Welfare legislation.
Issued by the Department of Social Protection
157/164 Townsend Street, Dublin 2
Revised April 2008
PART 1 MEDICAL CERTIFICATION UNDER SOCIAL WELFARE LEGISLATION
DUTIES OF THE MEDICAL CERTIFIER
ASSESSING INCAPACITY TO WORK
DESCRIBING THE INCAPACITY FOR WORK
PROCEDURES FOR ISSUING CERTIFICATES
COMPLETING MEDICAL CERTIFICATES
DATING OF CERTIFICATES
FREQUENCY OF CERTIFICATES
CERTIFYING PATIENTS UNABLE TO ATTEND FOR MEDICAL ASSESSMENT
REFUSAL TO ISSUE CERTIFICATES
INCAPACITY DUE TO OCCUPATIONAL ACCIDENT OR DISEASE
ILLNESS DURING PREGNANCY
WORKING AND RECEIVING BENEFIT
CERTIFIER UNABLE TO PERFORM HIS/HER DUTIES
GENERAL AND HOSPITAL CERTIFICATION AGREEMENTS
PAYMENT FOR MEDICAL CERTIFICATION
PART 2 OVERVIEW OF THE MEDICAL REVIEW AND ASSESSMENT SYSTEM
THE PURPOSE OF THE MEDICAL REVIEW AND ASSESSMENT SYSTEM
HOW THE SYSTEM WORKS
THE MEDICAL ASSESSMENT
1. DUTIES OF THE MEDICAL CERTIFIER
The duties of a Medical Certifier under Social Welfare Legislation are to:
examine patients who are making claims to illness or disability schemes and
complete and issue, free of charge to the patient, a medical certificate on the official form, where s/he is satisfied that the patient is incapable of work due to some specific disease or bodily or mental disablement;
complete and issue medical certificates of confinement, free of charge to the patient, on the official form in respect of Maternity Benefit Claims;
complete and return medical report forms, free of charge to the patient, when requested to do so by the Department.
2. MEDICAL CERTIFICATES
Medical Certificates are supplied in book form by the Department at the request of the certifier. The certifier is responsible for the safekeeping of the books.
Certificates must be used only for the purposes set out in section 1.
The MC1 book contains First and Final Certificates (Blue Forms). A First Certificate should be used for a new claim.
The MC2 book contains Intermediate (Yellow Forms) and Final Certificates (Blue Forms).
An Intermediate Certificate should be used where the claim is continuing.
A Final Certificate (MC1 or MC2 as appropriate) should be used where the patient is considered fit to resume work.
Books of certificates are supplied for the certifier's
own use. S/he
must not allow another certifier use any of his/her books of certificates
nor may s/he use books issued by the Department to another certifier. (See
paragraph 15 for an exception in the case of a deputising certifier).
Certifiers will be paid only for certificates written from books issued to them.
The instructions on the inside of the book of certificates should be noted carefully.
Always quote your Social Welfare
(DSP) Panel Number
clearly and legibly when completing certificates or reports for the Department.
Failure to do so may delay your payment.
3. ASSESSING INCAPACITY FOR WORK
To qualify for benefit under the provisions of Social Welfare legislation the patient must be incapable of work as a result of illness or injury.
The patient may be deemed to be incapable of work for any day when the following conditions are satisfied:
s/he is under medical care for a specific disease or bodily or mental disablement;
a registered Medical Practitioner certifies that s/he should stay away from work and s/he does not work because of the illness;
s/he is a probable source of infection from a disease classified as infectious according to the regulations under the Health Acts and s/he does not work, on the advice of a registered Medical Practitioner.
Capacity for work
Consideration must be given not only to the patient�s illness or injury; consideration must also be given where appropriate as to how the patient�s condition affects his/her ability to perform required job tasks, or exercise skills, for a particular job or for jobs in general. In addition, consideration must be given to the potential health and safety implications the patient�s condition might pose.
It is most important also, in the patient�s interest, to consider whether certification and advice to stay off work is the most appropriate way to manage a patient�s care. Prolonged absence from work may cause deterioration in a patient�s condition. For the most common health conditions, such as back pain and mild to moderate anxiety and depression, advice to stay at work or return to work early is recommended for a better clinical outcome. Reference to appropriate evidence-based clinical guidelines (e.g. for low back pain) is recommended in such cases.
Categories of work
Fitness for patient�s usual work, if employed, should be considered for an initial period of 6 months.
After this period or if the patient is unemployed, fitness for all categories of work should be considered (See
Appendix 3, Work Capacity Assessment).
4. DESCRIBING THE INCAPACITY FOR WORK
When completing a medical certificate a certifier must:
be satisfied that the patient is incapable of work;
certify that the patient is incapable of work;
indicate the specific disease or bodily or mental disablement that is the cause of the incapacity for work:;
state the cause of incapacity for work in legible and plain terms except in cases as follows:
where the patient's health could be affected by an exact statement of the nature of his/her illness
where the patient could suffer distress or injury as a result of the illness being revealed
In such cases the certifier should tick the code 93D on the First Certificate (MC1) or insert it in the incapacity box on the Intermediate Certificate (MC2). This will alert the Department to the serious nature of the incapacity. The Certifier should then notify the Chief Medical Adviser in writing of the exact cause of the incapacity.
To ensure payment for completed certificates/reports always quote your Social Welfare (DSP) Panel Number, sign, date and, where requested, include your name in BLOCK Letters.
5. PROCEDURES FOR ISSUING CERTIFICATES
Issue of Certificates
The issue of a medical certificate should be based solely on the certifier's opinion of the state of a patient's health.
A certifier may not:
accept money or other consideration in connection with the issue of a medical certificate;
make it a condition of the issue of a certificate that the patient should receive from him/her, and pay for, any medical advice, treatment, or medicine.
A patient seeking a first certificate should be medically examined and given a First Certificate where the certifier is satisfied that s/he is incapable of work.
In no circumstances should a First Certificate be issued
unless the patient is examined first.
If incapacity lasts longer than eight days after the date of the First Certificate, an Intermediate Certificate should be issued each week while the incapacity lasts, or at such intervals as directed by the Department (See Note).
An Intermediate Certificate should only be issued on the basis of the results of a medical examination where the certifier is satisfied for good medical reasons that the patient is still incapable of work.
NOTE: An Intermediate Certificate should not be given unless the certifier is satisfied that the patient continues to remain incapable of work.
It is not acceptable to issue certificates to a patient if you consider that s/he is fit to work.
The certifier should regularly review each case and ensure that a Final Certificate is issued, as appropriate, without delay.
A Final Certificate should be issued
only when the certifier is satisfied that the patient is fit to resume work on the day of examination or will be fit within the following three days.
You must quote your Social Welfare (DSP) Panel Number, sign, date and, where requested, include your name in BLOCK Letters, when completing certificates or reports for the Department.
6. COMPLETING MEDICAL CERTIFICATES
Each certificate must:
be completed clearly and legibly ensuring that the patient's name is entered on it;
state the certifier�s DSFA Panel Number clearly;
be written by the certifier in ink, preferably in CAPITAL LETTERS;
be signed and dated in the certifier's own handwriting - a rubber stamp should not be used;
be issued personally by the certifier to the patient (See Note 1);
be issued at the time of examination (See Note 2).
1. Certifiers must issue certificates personally. It is not acceptable for certificates to be completed or signed by anybody other than the certifier or Locum.
2. If for any exceptional reason this is not possible, the certificate must be given to the person within twenty‑four hours of the examination.
3. Certifiers are asked to advise patients to fully complete their part of the certificate as Benefit cannot be paid on incomplete certificates.
7. DATING OF CERTIFICATES
The date of examination
must be entered on each
A certificate must not be issued in any circumstances showing a date of examination when, in fact, the patient was
Your Social Welfare (DSP) Panel Number can be found on the front cover of your Books of Medical Certificates.
8. FREQUENCY OF CERTIFICATES
Normally a patient must be given a certificate each week for as long as incapacity for work lasts. However, the Department reviews claims regularly and, where illness has lasted for more than six months; the patient may be advised to send in only one medical certificate every four weeks. In cases of long‑term illness, a certificate once every six months will normally suffice.
The Department will advise the patient of any change in the certification frequency.
A certifier who considers that less frequent certification would be appropriate in a particular case should attach a note to the medical certificate requesting a review of the certification frequency and outlining the circumstances of the case.
When the Department has approved less frequent certification, the certifier must
not continue to certify weekly.
If the certifier has signed an Agreement for general certification (as distinct from certification in a hospital or similar institution) and the patient is unable to attend the surgery or clinic for examination, the certifier should examine the patient at home before issuing a First or Final Certificate.
9. BACK‑DATING CERTIFICATES
If a patient is incapable of work and has been under the care of a certifier for a considerable time before asking for certificates, the following should be completed and sent to the Department. Acceptance is at the discretion of the Department�s Chief Medical Adviser.
A First certificate (MC1) stating date illness began.
A certifier's note confirming that the patient has been attending on a regular basis. The note should give details of dates/frequency of visits and the reason why certificates were not issued at the time of the visits. It should also state whether the patient has been ill and incapable of work since the illness began. If the patient attends hospital as an out-patient the dates of attendance should be stated. If s/he was an in-patient the dates of admission and discharge should be stated. Please also note that backdated certificates can only be given to patients who were under your care at the time. A specific form (DB 93A) now exists where insufficient medical evidence is given in backdating cases and Illness Benefits Section will issue this form in such cases.
A current certificate (MC2).
To ensure payment for completed certificates/reports you must quote your Social Welfare (DSP) Panel Number, sign, date and, where requested include your name in BLOCK Letters.
10. CERTIFYING PATIENTS UNFIT TO ATTEND FOR MEDICAL ASSESSMENT
It is necessary for a patient claiming Illness Benefit to attend for assessment by a Medical Assessor of the Department when requested to do so unless they are certified unable to attend by their doctor. If you consider that a patient is unfit to attend for assessment due to illness, you must forward a certificate or report giving an update on their condition.
If a patient is certified unfit to attend for assessment on a regular basis, acceptance of such certification is at the discretion of the Department�s Chief Medical Adviser.
11. REFUSAL TO ISSUE CERTIFICATES
A certifier should refuse to issue a certificate if it is considered on medical grounds that the patient concerned is capable of work.
After a medical examination, if a certifier is satisfied that the patient is capable of work, s/he should refuse to issue a certificate, or issue a final certificate, as appropriate.
This instruction should be strictly observed to prevent the abuse of Public Funds.
A medical certifier who doubts the continuing incapacity of a patient, whom s/he is certifying as incapable of work or wishes to have a second medical opinion, should apply to have the patient examined by a Medical Assessor. The application should be made on the form MR4 to the Chief Medical Adviser, 157/164 Townsend Street, Dublin 2.
When the MR4 is received, a Medical Advisor reviews the case and decides whether an urgent assessment should occur. Please note that this form is not placed on the claimant's file in case it could be argued that it prejudices the examining Medical Assessor's opinion and is thus destroyed after the review of the form has been carried out and before the assessment is scheduled. On the MR4 form, the certifier should state the history of the case and the present condition of the patient. The patient's PPS No. should be quoted on all correspondence with the Department.
A certificate should not be refused because the patient is not receiving payment of benefit. The question of benefit entitlement is not a matter with which certifiers need be concerned. If the patient complains of not getting payment s/he should be advised to contact the relevant scheme section in the Department.
12. INCAPACITY DUE TO OCCUPATIONAL ACCIDENT OR DISEASE
If the illness is due to an occupational accident or a prescribed occupational disease, Injury Benefit may be payable. Prescribed diseases are certain diseases contracted due to the nature of the employment. They are listed in the Department's Information Leaflet,
SW33, which is available on request to LoCall Leaflet Line: 1890 202325.
A patient may also claim Injury Benefit in respect of a disease that is not prescribed but is contracted due to an occupational accident.
Accidents while on an unbroken journey to or from work can be regarded as occupational accidents.
You must always sign, date, quote your DSFA Panel Number and, where requested, include your name in BLOCK Letters when completing certificates or reports for the Department.
13. ILLNESS DURING PREGNANCY
If a patient is considered to be incapable of work due to illness and is also pregnant the certifier should state this fact on the medical certificate. Pregnancy per se is not an illness.It is essential that the EDD (Expected Delivery Date) is included on the certificate. Maternity Benefit may be payable for 26 weeks. In such cases, certificates of confinement on the official forms are required. Medical certificates should not be issued during this period.
14. WORKING AND RECEIVING BENEFIT
Illness Benefit patients are NOT permitted to work while claiming.
However, in certain circumstances the Department will grant permission for a person to undertake part-time work or training where it is of rehabilitative value or therapeutic in nature. The decision on such matters is exclusively one for the Department to make. Patients must first get written permission from the Department before starting work or training of any kind.
If the certifier is ill, absent from home or, for any other reason, temporarily unable to carry out his/her duties, s/he is required to arrange immediately, to the best of his/her ability, for a medical practitioner to deputise for him/her. The locum must be a medical certifier under Social Welfare legislation. The certifier should fully instruct the Locum as to the arrangements for the certification of patients. (For further information see
16. GENERAL AND HOSPITAL CERTIFICATION AGREEMENTS
Every certifier who wishes to undertake general medical certification must sign an agreement form MC8 (See
If a certifier wishes to issue certificates at a hospital or similar institution in addition to issuing them at his/her clinic or private home, s/he must sign a further agreement on form MC8(a) (See
Appendix 2) for the hospital at which s/he proposes to certify.
If a hospital certifier changes to another hospital s/he must complete a new form MC8(a).
In all cases, s/he should
only use the certificates issued to himself/herself as a certifier and
not the certificates that were sent to his/her predecessor at the hospital.
The Certifier should return all books of medical certificates, used and unused, immediately following conclusion of term of duty at hospital. Used books must be accompanied by completed
MC155 claim form. Books returned unaccompanied by
MC155 claim form will not be considered for payment.
The certifier should place a tick in the box provided on the medical certificate to indicate if a patient is an
inpatient in hospital.
17. PAYMENT FOR MEDICAL CERTIFICATION
Payment in respect of properly completed medical certificates and reports is made on an agreed fee-per-item basis to certifying doctors.
Payments are made quarterly. To ensure payment in a particular quarter, medical certificate counterfoils must be received in the Department on or before the last day of the quarter. Counterfoils received after the last day of a quarter will not be paid until the end of the next quarter.
Counterfoils returned between dates
Payment made at end of
1 February - 30 April
1 May - 31 July
1 August-31 October
1 November-31 January
Returning books of counterfoils for payment
Counterfoils must be returned intact to the Department for payment, i.e. they must not be separated from the books in which they were issued.
Normally only fully issued books of certificates (all certificates issued) should be returned for payment. The exception to this is where the certifier�s contract has ended.
Counterfoils returned by post
Counterfoils that are returned by post should be registered, or, at minimum, proof of posting should be obtained.
Counterfoils delivered by hand
Certifiers should ensure that they obtain a receipt for counterfoils that are returned by hand to Medical Review and Assessment Section.
Where counterfoils are alleged to have been lost, failure to produce proof of posting or a receipt, as appropriate, may result in non payment.
Certifiers should keep a record of the books that they are returning to the Department, e.g. retain a copy of the relevant claim form
Proper completion of counterfoils
Each counterfoil submitted for payment must show:
Patient�s PPS No.;
Date of issue/examination.
Payment will not be made in respect of blank or incomplete counterfoils.
Books of counterfoils must be submitted with a completed claim form
MC155 which must
be signed and dated in the certifier�s own handwriting;
show the certifier�s Panel Number;
be completed clearly, legibly and accurately.
Payment cannot be made without a properly completed claim form. Counterfoils may be returned to the certifier on request by registered post for re-submission with the properly completed form
MC155. A charge may be made for processing re-submitted claims for payment to cover postage and administrative costs, which may be deducted from the certifier�s payment.
Special reports are paid on a quarterly basis. Forms MR2 and MR33 are issued to request assessment of the medical condition of patients who are in receipt of Illness or Injury benefit. Form MR2 must be returned within ten days of issue. Both forms are valuable aids to Departmental Medical Assessors when determining whether a claimant should attend for assessment. They can, for example, prevent seriously ill claimants being called unnecessarily or allow a desk assessment to take place instead. Thus, their timely receipt is important.
Proper completion of special reports
Each special report must show:
Certifier�s printed name (BLOCK CAPITALS);
Certifier�s panel number.
Payment will not be made in respect of medical reports that are returned late or that are not completed properly.
Remember � always submit a properly completed Claim Form
MC155 with your certificate counterfoils when claiming payment. Failure to do so may delay payment.
Withholding tax certificates, F45s, are issued with each payment. These are valuable documents and should be retained by the certifier for tax purposes. The Department will charge for the issue of replacement F45s (F43/1).
Payment to Locum Medical Certifiers
Payment to a locum for certification is a matter for agreement between the locum and the Principal Certifier. The Locum must be a registered Medical Certifier with the Department. The Locum may use his or her own books to certify patients and claim payment from the Department accordingly. However, the locum may also use the Principal certifier�s Medical Certificates, and quote the certifier�s DSFA Panel Number, sign on the Certifier�s behalf
but it is extremely important especially when signing
Special Reportsto make it clear who the Principal Certifier is and state the fact that it is the Locum signing on the Certifier�s behalf. In such cases, payment will be made only to the certifier.
Health Service Executive forms are
not paid for by this Department.
18. IRREGULAR CERTIFICATION
A very serious view is taken of irregular or lax certification and practices such as the following will not be accepted.
Charging for the issue of certificates.
Issue of certificates by a person other than the certifier to whom the books of certificates was issued.
Engagement of a Locum who is not a registered Certifier.
Completion of a certificate when the patient has not been seen or examined by the certifier, e.g. pre-signing of certificates by certifiers for completion and issue by receptionists.
Issue of certificates that are not properly signed and dated � practices such as initialling or using a rubber stamp or other artificially produced signature are not acceptable.
Completion of certificate counterfoil with details of a person other than the person to whom the certificate was issued.
Issue of a certificate to a person who is considered by the certifier to be capable of work.
Continued issue of weekly certificates to patients who have been placed on less frequent certification by the Department.
Self-certification or that of a member of immediate family e.g. spouse/child by a Medical Certifier for the purposes of making a claim to a social welfare scheme.
Irregular certification action may lead to the imposition of monetary penalties, termination of the Certifier�s agreement, or referral to the Medical Council or relevant body.
Monetary penalties will have regard to the losses from Social Welfare funds incurred as a result of the irregular certification. The penalty may be recovered by withholding from payments due or as a simple contract debt.
19. CONTACT DETAILS
For supplies of MC1 and MC2 certificates please contact:
M.R.A. Section (Medical Certs)
157 ‑ 164 Townsend Street
Telephone Number: (01) 673 2072.
If any of your patients have queries on Illness Benefit, they can;
Telephone Illness Benefits Section at LoCall 1890 928 400
If you are calling from outside the Republic of Ireland please call + 353 1 7043300 if.
Illness Benefit Online Enquiry
Write to Illness Benefit Section, Department of Social Protection, Store Street, Dublin.1.
Part 2 Overview of the Medical Review & Assessment System (MRAS)
1. THE PURPOSE OF THE MEDICAL REVIEW AND ASSESSMENT SYSTEM
The Medical Review & Assessment System provides a system of independent second medical opinions and is the principal control mechanism for all illness, disability and carer schemes administered by the Department. Medical Assessors carry out medical review assessments, desk reviews and desk assessments of medical evidence/reports on patients to provide second medical opinions for the guidance of Deciding Officers and Appeals Officers. Designed in consultation with the medical profession, the system operates under the overall direction of the Chief and Deputy Chief Medical Advisers.
The work of the Medical Assessors necessarily brings them into close relationship with medical certifiers. It is important therefore, that certifiers should clearly understand the objectives of the Medical Review & Assessment System and the work of the Medical Assessors so that they are aware of how the system works and how effective co-operation between the Medical Assessors and the Certifiers helps to improve the efficiency of the Medical Review and Assessment System.
2. HOW THE SYSTEM WORKS
To qualify for payment under one of the Department's illness related schemes, patients must satisfy certain medical conditions. To establish entitlement or continued entitlement to a particular scheme, scheme sections refer cases to the MRA Section for medical review and assessment. A patient's entitlement to a particular scheme may be assessed or reviewed by way of a desk assessment of medical evidence and/or a medical assessment.
To assist the Medical Assessor in the assessment/review, the MRA Section or the relevant scheme section may request the certifier to complete a medical report. For specific schemes the certifier may also be requested to complete a similar medical report, which is attached to the application form. Medical report forms are of a standard format and are used for all schemes. The medical report is a detailed form which, when fully completed, gives the Medical Assessor a picture of the patient's disability and residual functional capacity. Based on this medical report the Medical Assessor may be in a position to express a medical opinion regarding the patient's entitlement to the Scheme. Otherwise, s/he may decide to call the patient for a medical assessment.
Properly and fully completed medical report forms, which are returned within the stipulated time frame(currently 10 days for the medical report form MR2), will be paid at the agreed rate. These payments will be included in the quarterly payment made to certifiers. Certifiers must quote their Panel Number, sign, date and, where requested, include name in BLOCK letters on medical reports, as otherwise payment cannot be guaranteed.
These payments will be included in the quarterly payment made to certifiers. Certifiers must quote their Panel Number, sign, date and, where requested, include name in BLOCK letters on medical reports, as otherwise payment cannot be guaranteed.
3. THE MEDICAL ASSESSMENT
Medical Assessments are carried out at prearranged times in Medical Review and Assessment Centres located throughout the country.
The Department's Medical Assessor carries out a medical assessment, which may include a clinical examination that is specifically designed to find out about a patient's illness or disability. The Medical Assessor does not make the initial diagnosis as this has already been done by the certifier. Rather, s/he assesses the patient to find out how the illness/disability affects the patient in everyday life or, if appropriate, whether or not the patient is fit for his/her usual work or for other categories of work.
A Nurse-Attendant will be present with the Medical Assessor during the assessment. The certifier may attend the medical assessment if s/he so wishes, and an interpreter if deemed necessary.
In all cases the certifier is notified of the Medical Assessor's opinion if the patient is found to be capable of work.
Responsibility remains with the certifier as to whether s/he should continue to issue medical certificates, but in carrying out this responsibility s/he will act with the full knowledge of the Medical Assessor's opinion. Similarly, while a Deciding Officer is bound to take the Medical Assessor's opinion into account, the decision as to whether benefit should continue to be paid in any particular case is a matter for the Deciding Officer and/or the Appeals Officer.
If a Deciding Officer disallows a patient's claim, that person has the right of appeal to the independent Social Welfare Appeals Office.
MC 8-General Certifier's Agreement (
PDF - 68KB in size)
MC 8A-Hospital Hospital Certifier's Agreement (
PDF - 68KB in size)
Work Capacity Assessment form (WC1) (
PDF - 60KB in size)
Electronic Funds Transfer (EFT) Payment Authorisation Form (
PDF - 57KB in size)
Medical Certificates Claim Form - MC155(
PDF - 99KB in size)