Making a complaint about a medical assessment provider

This page has been developed for use by customers who use a medical Assessment Provider as part of their journey for claiming benefit and also for staff in the Department for Communities (DfC) who manage complaints from customers. The aim is to provide a seamless complaints service for all our customers.

The DfC are committed to providing the highest standard of service to all our customers. Current government policy aims to make public services more responsible to their users. This means setting standards of service and acting quickly and effectively when these standards are not met or when things go wrong.

This page covers complaints about medical Assessment Providers for Personal Independence Payment (PIP), Employment and Support Allowance (ESA), Universal Credit (UC) and Industrial Injuries Disablement Benefit (IIDB).

Further advice is available from:

Definition

For the purpose of this policy, a complaint is:

If the Department for Communities receives a complaint that relates to a medical Assessment Provider, and the Assessment Provider has not had the opportunity to respond, then it should be passed to the Assessment Provider for them to answer. 

The only exception is where the complaint is about both the medical Assessment Provider and the service provided by the Department’s businesses. This is known as a joint complaint. The investigation of these complaints will be led by the Department with input requested from the Assessment Provider.

This policy does NOT apply where the complaint is about eligibility criteria or the policy associated with the support applied for.

Complaints made to the Assessment Provider

Complaints can be made to the Assessment Provider, either directly or indirectly via:

• written correspondence (white mail/email)
• verbally (phone call)
• in person (at an assessment)
• the customer service leaflet (UC, ESA and IIDB customers only)
• stakeholder forum
• third party (by the Department for Communities, Northern Ireland Public Services Ombudsman (NIPSO), Independent Case Examiner (ICE), Member of the Legislative Assembly (MLA) or Stakeholder)

The Complaints process for a standard complaint is presented below:

1. You complain about the services delivered by an Assessment Provider.
2. The complaint is received by the Assessment Provider.
3. The complaint is acknowledged by the Assessment Provider within 2 working days.
4. The Assessment Provider conducts research into your complaint.
5. A response letter will be provided by the Assessment Provider within 10 working days (Stage 1). The reply will also include details of the next stage (Stage 2) of the Assessment Provider’s complaints process.

Stage 2 complaint

If you are not satisfied with the response you have received to your initial complaint (Stage 1), and wish to complain again, your complaint will be treated as a Stage 2 complaint. It will be dealt with by a more senior person within the Assessment Provider’s organisation. Resolution will be provided by Assessment Provider within 10 working days and will include contact information for the Department for Communities if you are still not content.

Complaints made to the Department for Communities

If you have completed the two stages of complaint handling with the Assessment Provider and remain unsatisfied, you can raise a complaint with the Department for Communities. The final reply you received from the Assessment Provider will advise you how to contact the Department for Communities.  

You can ask for your complaint to be re-examined by the relevant Director in the Department for Communities. You will need to outline:

• Why you are dissatisfied with the response from the Assessment Provider, specifically why you do not accept what the Assessment Provider has said in their response, and
• The remedy you are seeking in relation to your complaint.

Someone from the Department for Communities will contact you by phone or in writing to confirm receipt of the complaint and identify the issues of your complaint that remain outstanding or which are new.

Departmental staff will contact the Assessment Provider to obtain copies of your original complaint, copies of the Assessment Provider complaints file, including any material gathered such as interview notes, clinical advice, audit advice, audio recordings (where available) and records of complaint analysis. 

In order to identify and carry out enquiries that independently test the Assessment Provider’s source material and findings against the complaint issues raised, staff responding to all complaints may seek input from the Health Assessment Advisory Team (HAAT). HAAT provides the Department with assurance about the quality of the health assessments carried out by Assessment Providers. 

Staff within Personal Independence Payment (PIP) may also consider input from the Quality Assurance Managers (QAM). QAMs monitor and provide feedback on the quality of decision making and provide direction and support on decision making to staff. 

Staff will keep a detailed record of all stages of the complaint investigation including the outcome and a brief synopsis of the lessons learned.

The Director will aim to respond to you within the agreed timeframe however, if for any reason there is a problem with collating the response, you will be notified of the delay and the reason for this and a new deadline for response will be provided.

Case Managers within DfC are not notified of complaints and do not have routine access to complaint issues raised. This allows claims to be processed while the complaint is being investigated. If the complaint leads to any change of advice from the Assessment Provider, this will be applied after the complaint process has concluded.

If you have received a reply from the Director and are still not satisfied, and you want an independent person to look into your complaint, you can phone or write to the Northern Ireland Public Services Ombudsman (NIPSO) or Independent Case Examiner (ICE). The Director’s reply will provide information on how to do this.

Contact details for assessment providers

Assessment Provider for Personal Independence Payment (Capita)

Phone: 0808 178 8116
Textphone: If you have speech or hearing difficulties, you can contact Capita by textphone on 028 9032 9675
Email: complaintsNI@capita-pip.co.uk

Assessment Provider for Employment and Support Allowance, Universal Credit and Industrial Injuries Disablement Benefit (ATOS)

Phone: 028 9002 7885
Email: customerrelationsteam@atos.dfcni.gov.uk