3 October 2005

Using the Freedom of information Act, Benefits and Work has obtained a copy of a 49 page document that exposes the extraordinary assumptions doctors assessing claimants’ capability for work are trained to make. This is a guide that should be on every welfare rights workers desk and will be of value to any claimant challenging a decision that they are incapable of work.

The purpose of the document is to explain the significance of each of the clinical findings, both physical and mental, of the computer generated LiMA Personal Capability Assessment reports. The meaning of physical terms such as ‘Wrist supination’ and visual ‘Acuity 6/18’ are clearly explained. Equally, the relevance to mental health – in the opinion of Atos Medical Services - of such things as skin tanning, dress, eye contact, fiddling and rocking are all set out.

The terms are organised in the same order that they appear in LiMA medical reports, making it easy to look them up

Physical health
So, for example, when a claimant or welfare rights worker reads in a medical report that ‘Wrist pronation reduced to 40 -60°’ they will now be able to discover that the examining doctor considers that the claimant’s ‘Wrist twists inward about halfway’ and that this ‘Suggests reduced function’.

On the other hand, if the doctor records that their claimant’s ‘Wrist Dorsi – Flexion’ is ‘30° or more’ this means that the client’s ‘Wrist bends backwards as normal’ and this ‘Shows good wrist function’. If, in reality, the claimant cannot bend their wrist backwards as normal without pain or severe discomfort then this is an issue on which it may be possible to gather alternative medical evidence and one about which the claimant can give evidence in person at an appeal hearing.

Every single medical term used in computer led examinations is explained in the document in terms intended to be understood by the lay reader.

Mental health
In relation to mental health, the document reveals the enormous assumptions that are made based on limited and somewhat dubious evidence. For example, under ‘Complexion’ the examination finding ‘Is tanned’ apparently ‘Suggests good health’ whilst ‘Looks pale’ apparently ‘Suggests poor health’.

Similarly the examination finding ‘Looks well’ seemingly ‘Suggests good health’, whilst ‘Looks very well’ seemingly ‘Suggests very good health’ and ‘Looks unwell’, you won’t be surprised to learn, ‘Suggests poor health’.

If claimants are ‘Neatly’. ‘Smartly’ or ‘Casually’ dressed this ‘Suggests good drive’ whilst wearing ‘dirty clothes’ or ‘worn-out clothes’ in the opinion of Atos doctors ‘Suggests poor drive’ and wearing ‘mismatched’ clothing ‘Suggests disorganisation’. The possibility that smartly dressed people may have made a special effort because they’re seeing a doctor or may have been assisted by someone else doesn’t seem to occur to Medical Services staff. Perhaps less surprisingly, given the £100,000 plus earning capacity of Atos doctors, they also don’t seem to have considered the possibility that worn out clothing may denote a lack of cash rather than a lack of drive.

The document warns the lay reader that ‘no one examination finding should be taken in isolation’ and that the evidence from such things as the medical and typical day histories must also be considered. It would be reassuring to believe that the computer controlled examining doctors don’t themselves take short cuts and base their findings on very limited evidence - sadly experience suggests otherwise. This document will, at least, allow claimants and representatives a much better opportunity to expose and challenge incorrect conclusions based on what are clearly often highly subjective examination findings.

As ever, due to copyright restrictions imposed by Atos Origin, we can’t publish a copy of this document. However, Benefits and Work members can copy copy and paste a simple email in order to be sent their own copy for free using the Freedom of Information Act.


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