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Regulation 19 Determination of limited capability for work

England, Wales and Scotland

(1)

For the purposes of Part 1 of the Act, whether a claimant's capability for work is limited by the claimant's physical or mental condition and, if it is, whether the limitation is such that it is not reasonable to require the claimant to work is to be determined on the basis of a limited capability for work assessment of the claimant in accordance with this Part.

(2)

The limited capability for work assessment is an assessment of the extent to which a claimant who has some specific disease or bodily or mental disablement is capable of performing the activities prescribed in Schedule 2 or is incapable by reason of such disease or bodily or mental disablement of performing those activities.

(3)

Subject to paragraph (6), for the purposes of Part 1 of the Act a claimant has limited capability for work if, by adding the points listed in column (3) of Schedule 2 against F1each descriptor listed in that Schedule F2which applies in the claimant’s case, the claimant obtains a total score of at least—

(a)

15 points whether singly or by a combination of descriptors specified in Part 1 of that Schedule;

(b)

15 points whether singly or by a combination of descriptors specified in Part 2 of that Schedule; or

(c)

15 points by a combination of descriptors specified in Parts 1 and 2 of that Schedule.

F3(4)

In assessing the extent of a claimant’s capability to perform any activity listed in Part 1 of Schedule 2, the claimant is to be assessed as if—

(a)

fitted with or wearing any prosthesis with which the claimant is normally fitted or normally wears; or, as the case may be,

(b)

wearing or using any aid or appliance which is normally, or could reasonably be expected to be, worn or used.

F4(5)

In assessing the extent of a claimant’s capability to perform any activity listed in Schedule 2, it is a condition that the claimant’s incapability to perform the activity arises—

(a)

in respect of any descriptor listed in Part 1 of Schedule 2, from a specific bodily disease or disablement;

(b)

in respect of any descriptor listed in Part 2 of Schedule 2, from a specific mental illness or disablement; or

(c)

in respect of any descriptor or descriptors listed in—

(i)

Part 1 of Schedule 2, as a direct result of treatment provided by a registered medical practitioner for a specific physical disease or disablement; F5or

(ii)

Part 2 of Schedule 2, as a direct result of treatment provided by a registered medical practitioner for a specific mental illness or disablement.

(6)

Where more than one descriptor specified for an activity F6applies to a claimant, only the descriptor with the highest score in respect of each activity which applies is to be counted.

(7)

Where a claimant—

(a)

has been determined to have limited capability for work; or

(b)

is to be treated as having limited capability for work under regulations 20, 25, 26, 29 or 33(2),

the Secretary of State may, if paragraph (8) applies, determine afresh whether the claimant has or is to be treated as having limited capability for work.

(8)

This paragraph applies where—

(a)

the Secretary of State wishes to determine whether there has been a relevant change of circumstances in relation to the claimant's physical or mental condition;

(b)

the Secretary of State wishes to determine whether the previous determination of limited capability for work or that the claimant is to be treated as having limited capability for work, was made in ignorance of , or was based on a mistake as to, some material fact; or

(c)

at least 3 months have passed since the date on which the claimant was determined to have limited capability for work or to be treated as having limited capability for work.

Annotations

Textual amendments

F1

Words in reg. 19(3) substituted (29.10.2013) by The Social Security (Miscellaneous Amendments) (No. 3) Regulations 2013 (S.I. 2013/2536), regs. 1(1), 13(7)(a)(i)

F2

Words in reg. 19(3) inserted (29.10.2013) by The Social Security (Miscellaneous Amendments) (No. 3) Regulations 2013 (S.I. 2013/2536), regs. 1(1), 13(7)(a)(ii)

F3

Reg. 19(4) substituted (28.1.2013) by The Employment and Support Allowance (Amendment) Regulations 2012 (S.I. 2012/3096), regs. 1(1), 3(2)(a)

F4

Reg. 19(5) substituted (28.1.2013) by The Employment and Support Allowance (Amendment) Regulations 2012 (S.I. 2012/3096), regs. 1(1), 3(2)(b)

F5

Word in reg. 19(5)(c)(i) inserted (29.10.2013) by The Social Security (Miscellaneous Amendments) (No. 3) Regulations 2013 (S.I. 2013/2536), regs. 1(1), 13(7)(b)

F6

Word in reg. 19(6) substituted (29.10.2013) by The Social Security (Miscellaneous Amendments) (No. 3) Regulations 2013 (S.I. 2013/2536), regs. 1(1), 13(7)(c)

Notes on the whole SI

Textual amendments

F1

Section 3(3) is cited for the power to prescribe a payment under paragraph (b) of the definition of “pension payment”.

F2

Section 22 is cited insofar as it relates to paragraphs 1 to 3, 6, 7, 8(1), 9 and 10 of Schedule 2.

F3

Section 24(1) is cited for the definition of “employment” and “employed”, “period of limited capability for work”, “prescribed”, “regulations” and “week”.

F4

Paragraph 6(5) of Schedule 1 is cited for the definition of “couple”, “education” and “remunerative work”.

F5

2007 c. 5.

F6

1992 c. 5.

F7

1998 c. 14.