Upper Tribunal (Administrative Appeals Chamber)

[2009] UKUT 56 (AAC) (23 March 2009)
Incapacity benefits
attending medical examination

THE UPPER TRIBUNAL (ADMINISTRATIVE APPEALS CHAMBER) Upper Tribunal Case No. CIB/3117/2008
APPEAL AGAINST A DECISION OF A TRIBUNAL
DECISION OF THE UPPER TRIBUNAL JUDGE WIKELEY
DECISION OF THE UPPER TRIBUNAL (ADMINISTRATIVE APPEALS CHAMBER)

The DECISION of the Upper Tribunal is to allow the appeal by the appellant.

The decision of the Cheltenham appeal tribunal dated 4 June 2008 under file reference 205/08/00178 involves an error on a point of law. The tribunal's decision is set aside.

The Upper Tribunal is able to re-make the decision under appeal. The decision that the tribunal should have made is as follows:

The appeal by the appellant against the decision of the Secretary of State dated 19 November 2007 succeeds.

It has not been established that the appellant failed to show 'good cause' for failing to submit himself for a medical examination on 22 October 2007.

The case is remitted back to the Secretary of State with the following directions:

(i) The Secretary of State shall ask Medical Services to arrange for the appellant to be provided with details, in writing, of the conditions under which an interview or examination may be tape-recorded;

(ii) The Secretary of State shall ask Medical Services to offer the appellant a further appointment for a medical examination.

If Medical Services and the appellant are unable to agree the terms on which such a medical examination is to take place, and the appellant declines to attend for or submit to such an examination, the Secretary of State is of course at liberty to make a fresh decision under regulation 8 of the 1995 Regulations. The appellant will, of course, then have a fresh right of appeal to the First-tier Tribunal. In such circumstances the onus will be on the appellant to show he has 'good cause' for his failure to attend for or submit to such an examination.

This decision is given under section 12(2)(b)(ii) of the Tribunals, Courts and Enforcement Act 2007.

REASONS FOR DECISION

The decision in summary

1. The appellant's appeal to the Upper Tribunal (formerly the Social Security Commissioner) is allowed. The decision of the Cheltenham appeal tribunal dated 4 June 2008 under file reference 205/08/00178 involves an error on a point of law. I re-make that decision in the terms as set out above.

T The impact of the new tribunal system on this case

2. This case started as the appellant's appeal to the Social Security Commissioner against the appeal tribunal's decision. On 3 November 2008 the Tribunals, Courts and Enforcement Act 2007 replaced the appeal tribunal with the Social Entitlement Chamber of the First-tier Tribunal.
3. The functions of the Social Security Commissioners were taken over by the Judges of the Administrative Appeals Chamber of the Upper Tribunal with effect from the same date. These changes have been made with a view to improving the system of administrative justice as a whole. However, the substantive law relating to entitlement to incapacity benefit and issues of 'good cause' remains unchanged.

The issues in this appeal

4. The primary legal issue in this appeal is relatively straightforward. The question is this: was this tribunal right to decide that the appellant had not shown good cause for failing to submit to a medical examination for the purposes of incapacity benefit? I conclude that the tribunal applied the law incorrectly.
5. The underlying legal issue, however, is more complex. Does a claimant have a right to insist on tape-recording, on his own terms, such an incapacity benefit medical examination? I suggest that he does not, but do not need to resolve that question definitively. I provide some guidance on the application of the 'good cause' principle in such cases.

The background to the appeal to the tribunal

6. The appellant has been incapable of work due to chronic fatigue since January 2007. He has received income support (and national insurance credits) on the basis of his incapacity for work.
7. A person who receives a social security benefit because of incapacity for work may be required to attend periodically to attend for a medical examination. The appellant was duly notified of such an appointment and attended at the relevant Medical Examination Centre at the appropriate time on 22 October 2007. He was seen (briefly) by Dr P (a sessional medical examiner) and then (again briefly) by Dr D (a salaried medical examiner). He did not actually have a medical examination.
8. The sequence of events at the Medical Examination Centre is best described by reference to the handwritten "Record of Proceedings" prepared by Dr D shortly after the incident in question. I note, however, that the appellant disputes some of the details of this account, although these differences do not need to be resolved for the present. The relevant passage reads as follows:

'His [the appellant's] file was given to Dr P, but on entering the examination room he switched on a hand-held tape recorder. Dr P declined to proceed in this situation, and asked that [the appellant] be seen by me, as a salaried full-time Medical Adviser. I entered [the appellant's] NINO and IB50 descriptor choices into LIMA [the computer programme used at such examinations], and then invited [the appellant] to come from the waiting room to the examination room at 9.17 a.m. As he entered the examination room he switched on the same hand-held (single-tape) tape recorder. I informed him that it was not possible to proceed under these conditions because we have been instructed that any interview/examination can only be tape-recorded if the claimant provides, (at their own expense), the facility to produce 2 contemporaneously recorded tapes. He said he knew this, but wished to make a single tape recording to "preserve his rights". Accordingly, I declined to proceed, and politely escorted him to the Waiting Room, after he had agreed that the interview/ examination would be terminated for the above reasons. He left the building without causing a disturbance.'

9. On 19 November 2007 a decision maker superseded the earlier decision awarding the appellant national insurance credits. The stated basis for the supersession was a change in circumstances, namely that the appellant had failed without good cause to submit himself for a medical examination. The supersession was with effect from 23 October 2007, the day after the incident at the Medical Examination Centre.
10. The appellant lodged an appeal. He emphasised that he had attended for a medical, that he had not refused to be examined and that it was the doctors, not him, who had 'aborted the examination'. He argued that in wishing to tape-record the interview he was 'well within my rights to protect myself as to ensure a fair and impartial examination'.

The Cheltenham appeal tribunal's decision

11. The appellant opted for a paper hearing of his appeal. A tribunal, comprising a lawyer member sitting alone, dealt with the appeal at Cheltenham on 4 June 2008. The tribunal dismissed the appeal and confirmed the Secretary of State's decision.
12. The tribunal's Decision Notice, issued on the day, stated that the appellant had imposed such conditions on the medical examination that it had not been carried out and that he had therefore failed to submit himself for such an examination (within regulation 8(1) of the Social Security (Incapacity for Work) (General) Regulations 1995 (SI 1995/311)). Furthermore, the tribunal stated that the appellant had not shown good cause for that failure (within regulation 9 of the same Regulations), and so was to be treated as capable of work.
13. The tribunal chairman subsequently issued a Statement of Reasons for the tribunal's decision, elaborating on these findings. A central plank in the tribunal's reasoning was as follows:

'The examination could not be conducted under [the appellant's] conditions. In CIB/849/2001 it was said that going to the medical examination but refusing to be examined constitutes attendance but also a failure to submit. Imposing unacceptable conditions is a "failure to submit".'

Why the appeal tribunal decision involves an error of law

14. Regulation 8(1) of the 1995 Regulations provides that 'where a question arises as to whether a person is capable of work' the Secretary of State may require that person to attend for a medical examination. Regulation 8(2) then provides that 'where a person fails without good cause to attend for or submit himself to such an examination, he shall be treated as capable of work'.
15. Social security legislation sometimes defines the concept of 'good cause' very precisely and very restrictively (e.g., in relation to good cause for late claims for benefit). In the present context, however, the issue of 'good cause' is left at large, subject to certain factors which must be taken into account, as listed in regulation 9 (such as the person's state of health and the nature of any disability).
16. The tribunal in the present case relied on the decision of Mr Commissioner Turnbull in CIB/849/2001. In that case the appellant had attended for his medical but had refused to be examined unless he was given a guarantee that the report of the medical examination would not be seen by any layperson. The examining doctor declined to give him any such assurance, as the decision-making system was (and is) based on the principle that the final decision is made by a Departmental official who is not medically qualified (then an adjudication officer, now a decision maker).
17. In CIB/849/2001 an adjudication officer duly decided that the appellant had failed without good cause to attend or submit to a medical examination. The tribunal in that case rejected his argument that he had not refused to submit to a medical examination. Mr Commissioner Turnbull rejected his further appeal in the following terms (at paragraph 11):

'The Tribunal rightly rejected that argument. The purpose of the medical examination was of course to enable the adjudication officer, with the benefit of the doctor's report, to determine whether the Claimant passed the all work test. The condition which the Claimant wished to impose on his submitting to an examination – i.e. that the doctor's report should not be passed to any layman, including an adjudication officer – rendered an examination useless for the purpose for which it was required. I have no doubt that, by imposing such a condition, the Claimant was failing to submit himself to a medical examination within the meaning of Reg. 8(2). A person "fails" to submit himself to an examination not only if he absolutely refuses to be examined, but also if he seeks to impose as a condition of being examined a term which would render the examination useless for the purpose for which it is required.'

18. It follows that Mr Commissioner Turnbull was not laying down a general principle that imposing unacceptable conditions on being examined amounts to a failure to submit to an examination. It was unnecessary to do so for the purposes of that case. Rather, the Commissioner decided that a person fails to submit to an examination 'if he seeks to impose as a condition of being examined a term which would render the examination useless for the purpose for which it is required.'
19. There is no suggestion in the present case that the appellant's insistence on tape-recording the examination on his own terms, rather than the Department's terms, would render it 'useless for the purpose for which it is required.' To that extent the tribunal was clearly wrong to find that 'The examination could not be conducted under [the appellant's] conditions'. It could have been so conducted. Rather, the issue was that the conditions that the appellant was seeking to impose were in conflict with the Departmental policy about tape-recording such examinations.
20. So in the present case the tribunal was effectively applying a broader principle than that established in CIB/849/2001, namely that a claimant who declines to accept any reasonable condition attached to the conduct of a medical examination has thereby failed without good cause to submit to such an examination.
21. In addition, the tribunal in the present case made no findings as to the reasonableness or otherwise of the official policy about tape-recording medical examinations. It simply assumed that the Departmental policy was reasonable and that therefore the appellant had not shown good cause for refusing to submit to the medical examination. The tribunal also failed to consider whether the appellant had been given an adequate opportunity to consider his options in the light of the stated policy. Although the Medical Examination Centre proforma reporting the incident has a box ticked to say that the appellant "refused" a new appointment, it is by no means clear that he was actually offered one and, if so, on what terms.
22. The misunderstanding by the tribunal of the extent of the principle in CIB/849/2001 and the failure to make appropriate findings of fact in relation to the issue of the reasonableness (or otherwise) of the conditions and the question of good cause involve errors of law. I therefore allow the appeal and set aside the tribunal's decision.
23. There is no point whatsoever in sending this case back to a new tribunal to be re-heard. I am therefore re-making (or substituting) my decision for that of the tribunal. My decision is as set out on page 1 above. The parties' submissions and my reasons for making the decision in those terms are as follows.

The Secretary of State's submissions to the Upper Tribunal

24. The Secretary of State's representative now involved in this case concedes, in a detailed submission, that the appellant attended as requested for the medical examination. He also accepts that in principle the appellant's wish to tape-record the examination was 'perfectly reasonable'. However, he points out that from time to time criticisms are levelled against doctors carrying out medical examinations for the Department. He therefore argues that it is in the interests of justice for the examining doctor to be provided with a copy of the recording, thereby necessitating two copies being made contemporaneously. He further contends that it is right and proper that the cost of arranging such a dual recording should fall on the person who wishes to have the examination tape-recorded.
25. The Secretary of State's representative also acknowledges that there is no mention in the standard letters and leaflets provided to claimants about the possibility of taking a written note of the medical examination, or of the terms on which it may be tape-recorded. There is, however, a reference to the right to have a friend, carer or family member present, and to the option of having an officially provided chaperone in attendance.
26. The submission by the Secretary of State's representative also helpfully includes an extract from the Department's Medical Services Guidance on the issue of recording medical examinations. It must be remembered that this is a statement of Departmental policy and not of law. It reads as follows:

'Audio or Video Tape records of Examinations

Any requests by claimants to tape an examination should not be directly refused, but our policy in these circumstances should be fully explained to them. The Department for Work and Pensions (DWP) never requires that a medical assessment for the purpose of advising on entitlement to state sickness or disability benefits be recorded on audio or videotape.

Claimants may request that their interview and assessment by a Medical Services doctor in respect of a benefit claim be recorded either on audio or videotape. Such a request can only be agreed with the prior consent of the HCP [health care professional, in this case an examining doctor], and then only if stringent safeguards are in place to ensure that the recording is complete, accurate, and that the facility is available for simultaneous copies to be made available to all parties present. The recording must be made by a professional operator, on equipment of a high standard, properly calibrated by a qualified engineer immediately prior to the recording being made. The equipment must have facility for reproduction so that all parties can retain a copy of the tape.

The responsibility for meeting the cost of the above requirement rests with the claimant.

Any request by a claimant for an assessment to be audio or videotaped must be declined unless the above safeguards are in place. The claimant must instead be offered the opportunity of a rescheduled assessment in the presence of a companion or other witness. If the claimant refuses this opportunity and refuses to proceed with the assessment, the HCP should return the file to the DWP explaining the situation.'

27. The Secretary of State's representative suggests that the interests of justice require that the appellant is given proper notice of those conditions in writing and offered a further appointment at which – if those (official) conditions are satisfied – the examination could be tape-recorded. He invites me to remit the matter to the Secretary of State on that basis.

The appellant's submissions to the Upper Tribunal

28. The appellant has also made detailed and extensive submissions. His fundamental argument is that he did attend the examination and that he did not refuse to be examined. Contrary to Dr D's note of the discussion, the appellant states that he had not previously been aware of the policy of dual recording and was not given the opportunity to make a future appointment on that basis. He also, very reasonably, makes the point that it is unrealistic to expect a person living on social security benefits to be able to afford to meet the cost of dual tape-recording under the Department's conditions.
29. The appellant's submissions also include some more sweeping comments that may explain his insistence on tape-recording the medical examination. He writes that the Secretary of State's decision came as no surprise, 'as I uncovered the political intentions to manipulate statistics hitting citizens to make them illegible [sic] for benefits'. He alleged that the Department had 'falsified records to justify depriving me of entitlements'.
30. The appellant added that whilst his own doctors were concerned with his health, 'the DWP medical examiners are mainly concerned with finding reasons to support the DWP in cancelling entitlements'. Accordingly, he argued, 'I can well understand why they did not want to have the examination recorded, as it is evidence that would stand in a court of law in any possible action against the DWP's medical examiners'.
31. In addition to his correspondence, the appellant has also submitted a detailed statement running to eight typed pages detailing the chronology of various events going back to 2002. They include complaints against the local social services department, the county police force and various courts about their actions in relation to a range of civil and criminal matters. They appear to have started with child protection proceedings involving the appellant's disabled son.
32. The appellant's statement appears to have been compiled as part of judicial review proceedings that he has launched in the Administrative Court against his local Crown Court. There is also a reference to an application by him to the European Court of Human Rights. The statement does not directly relate to the appellant's dealings with the Department for Work and Pensions and clearly it would be inappropriate for me to comment on those various other proceedings.
33. However, the appellant's statement is helpful in that it indicates the nature and extent of his concerns about officialdom in its various guises. He argues that in his view in these other proceedings 'public authorities fabricated evidence to pervert the course of justice', that his own evidence was 'irrefutable' and that 'the credibility and evidence of public authorities was, and remains, in serious question'.
34. In his 'skeleton argument' the appellant argues that 'when a public authority makes a mistake or wishes to avert a public embarrassment the truth and/or justice is usually compromised'. This highlights, the appellant contends, 'the need for protecting oneself' – and so, he submits, the need to tape-record the medical examination.

The outcome of this appeal to the Upper Tribunal

35. The immediate outcome and disposal of this appeal to the Upper Tribunal is straightforward. As explained above, the tribunal's decision involves an error of law. I set aside the decision of the tribunal under section 12(2)(a) of the Tribunals, Courts and Enforcement Act 2007.
36. I can, however, re-make the decision. The decision that the tribunal should have made is set out in bold on page 1 above. In essence it is that the Department should (a) set out in writing to the appellant the conditions they insist on for tape-recording a medical examination and (b) offer the appellant a fresh appointment.
37. If the Department and the appellant are unable to agree the terms on which such a medical examination is to take place, and the appellant declines to attend for or submit to such an examination, the Secretary of State is of course at liberty to make a fresh decision under regulation 8 of the 1995 Regulations. The appellant will, of course, then have a fresh right of appeal to the First-tier Tribunal. In such circumstances the onus will be on the appellant to show he has 'good cause' for his failure to attend for or submit to such an examination (see Commissioner's decision R(S) 9/51).

What if there is a further refusal to undergo a medical unless it is tape-recorded on the appellant's (and not the Department's) terms?

38. The reality, however, is that this case may involve an irresistible force – the appellant's apparent insistence on tape-recording the medical on his terms – meeting an immoveable object – the Department's insistence on any examination being recorded only on its terms.
39. It is possible that some form of compromise may yet be reached. For example, the Department accepts that a family member or friend may accompany the appellant to a medical examination. Such a companion may of course keep a note, and even a verbatim note, of the proceedings. That may be acceptable to the appellant.
40. The possibility remains that the impasse will not be broken. In that event there is a real risk that a future tribunal will be faced with adjudicating upon a similar dispute, following a refusal by the Department to accede to the appellant's request and a refusal by the appellant to modify his stance.
41. Clearly it would be not be right for the Upper Tribunal to provide a definitive view on a matter which is at present hypothetical. That said, it is the role of the Upper Tribunal to provide guidance in appropriate cases. This is one such case given the likelihood that the present circumstances may recur (either involving this appellant or indeed another claimant).
42. I entirely accept the appellant's point that the accuracy of a third-party note may be challenged after the event in the way that a tape-recording may not be. The appellant, however, must also recognise that there may be sound reasons for the Department's resistance to the use of single-reel machines by claimants to tape-record medical examinations.
43. In the present case there is no suggestion that the appellant is acting in bad faith. But the Department will be understandably concerned that such recordings may be disseminated more widely (e.g. by claimants posting them on the internet) without the consent of the examining doctor. There is also the very real (and not fanciful) risk that unscrupulous individuals might digitally re-master such a recording and then use it as 'evidence' in a spurious complaint against the doctor, either internally or to the General Medical Council.
44. In those circumstances it is difficult to see how the appellant, or anyone else in his position, has an absolute right to tape-record a medical examination on his own terms. This is not to say that the Department's restrictive policy about tape-recording cannot be challenged.
45. The appellant makes a number of good points in this context. He draws attention to the considerable (and probably prohibitive) cost that would be involved for an individual living on benefits in meeting the Department's restrictive criteria. He rightly points out that those conditions (which include the presence of a qualified engineer) are actually stricter than those in place for police interviews with suspects. He might also have added that the Department's own protocols for interviewing claimants under caution in the course of benefit fraud investigations do not require the presence of a qualified engineer (although dual-tape machines and sealed tapes are used).
46. On the other hand, many claimants might well regard it as an invasion of their privacy if they were told that as a matter of course Departmental medical examinations were to be tape-recorded. They might well have concerns about issues of medical confidentiality and be reluctant to discuss more sensitive aspects of their condition.
47. There would also of course be considerable cost implications for the Department. Parliament has decided on certain safeguards both for interviewing officers and suspects in police investigations. As yet Parliament has not made similar provision in the very different context of a medical examination for the purposes of assessing entitlement to benefit.
48. Any challenge to the current Departmental policy as regards the recording of medical examinations might well have to be by way of proceedings for judicial review. It would not be appropriate for the Upper Tribunal to express any view on the prospects of such a challenge.
49. If this type of case comes up again before a tribunal, it is important to bear in mind that the central issue in dispute is not the reasonableness or otherwise of the Departmental policy. Instead, the key issues are (i) whether the Secretary of State has shown on the balance of probabilities that a claimant has failed 'to attend for or submit himself to such an examination' and then, if so, (ii) whether the claimant has shown, again on the balance of probabilities, that he or she has 'good cause' for that failure.
50. Mr Commissioner Rowland explained the position as follows in CIB/2645/1999, a case in which the claimant had refused to be examined by a doctor in the presence of a chaperon:

'Of course, a claimant is always entitled to refuse a medical examination but, if the examination is arranged under regulation 8(1) with the notice required by regulation 8(3), he or she must accept that the consequence will be a decision under regulation 8(2), treating him or her as capable of work, unless there is good cause for the refusal. A doctor is entitled to insist on a suitable chaperon being present and a claimant who unreasonably refuses to allow such a chaperon to be present is to be taken to be refusing to submit to the examination. No reasonable explanation has been proffered for the objection to the chaperon in this case.'

51. In the later case of CIB/2011/2001, the same Commissioner acknowledged that 'the integrity of the social security system depends on there being appropriate tests [i.e. in this context medical examinations] in place' (paragraph 16). A tribunal must balance that public interest against the individual's private interest, which is measured by whether he has 'good cause', taking into account any relevant considerations and the matters particularly mentioned in regulation 9 of the 1995 Regulations.
52. The decision of Mrs Commissioner Brown in C1/07-08, a Northern Ireland decision, is also relevant. In that case the claimant suffered from M.E. He declined to remove any of his clothing and refused to allow the examining doctor to move any of his limbs. The examination was terminated. The tribunal found that the claimant did not have good cause for his failure to submit to a medical examination.
53. Mrs Commissioner Brown dismissed the claimant's further appeal. She concluded that 'the nature and extent of the examination is a matter for the examining doctor' (paragraph 12). However, when the Commissioner stated that ' the extent and format of the examination was for the clinician performing it', I am confident that she was referring to the 'extent and format' of the clinical aspects of the examination, and not the surrounding circumstances (such as whether or not it was being tape-recorded).
54. Mrs Commissioner Brown in C1/07-08 also emphasised that associated with the notion of 'good cause', and in addition to the specific factors listed in regulation 9 of the 1995 regulations, were 'all the implications of objective reasonableness which that phrase implies'.
55. In practice most successful appeals on 'good cause' are probably based either on the claimant's ill health at the time of the appointment or the non-receipt of the formal notification of the appointment (see e.g. the decision of the Northern Ireland Deputy Commissioner in C11/03-04 (IB)). However, the jurisprudence on 'good cause' for not participating in medical examinations goes back to the early case law of the National Insurance Commissioners.
56. In R(S) 9/51, the claimant, who was a Christian Scientist, refused to attend for or submit herself to a medical examination for the purposes of assessing her entitlement to sickness benefit. The Commissioner held that her objection was based on a firm conviction that her religious belief required her to refuse the medical and that on the facts this amounted to good cause. In particular, the Commissioner emphasised that

'the ultimate question is not what is the doctrine of the claimant's church or other association but what is his personal attitude – i.e., is his objection based on a firm conviction that his religious belief requires him to refuse to submit to examination and not upon mere prejudice or distaste for the process?' (paragraph 6).

57. Professor Calvert, in the first textbook on the subject, describes this decision as 'quite lenient' (H. Calvert, Social Security Law, 2^nd edition, 1978, p.221). It may be, however, that the decision is a recognition of the weight to be attached to deeply held religious or other conscientious beliefs – so, for example, in an unemployment benefit appeal a vegetarian had 'good cause' for refusing to apply for a vacancy as a secretary in a sausage and pie makers (CU 14/68).
58. The jobseeker's allowance scheme now seeks to define 'good cause' more fully, and for example makes express provision for a refusal to participate in a training scheme which results from 'a religious or conscientious objection sincerely held' (Jobseekers Allowance Regulations 1996 (SI 1996/207). The scope of such an objection was fully analysed by Mr Commissioner Bano in R(JSA) 7/03, where the Commissioner noted that 'a principled objection is not the same as a conscientious objection' (paragraph 17; see also CSJSA/495/2007).
59. The different statutory contexts of the incapacity benefit and jobseeker's allowance schemes must be borne in mind. However, it must also be recognised that the concept of 'good cause' in relation to both benefits shares a common heritage in the former sickness and unemployment benefit schemes. I also repeat Mr Commissioner Rowland's observation in CIB/2011/2001 (at paragraph 16) that 'the integrity of the social security system depends on there being appropriate tests in place', subject always to the safeguard of 'good cause'. Those tests include both medical examinations and engagement with training programmes.
60. Finally, I must acknowledge that there is no suggestion in this case that the appellant has acted other than in an open and straightforward manner. This is not, therefore, a case in which a claimant has surreptitiously tape-recorded an interview or medical examination. That type of case may well involve different considerations, e.g. as regards the admissibility of evidence in subsequent tribunal proceedings (on which see the decision of the Employment Appeal Tribunal in Chairman & Governors of Amwell View School v Dogherty (UKEAT/0243/06/DA).

Summary of conclusions

61. For the reasons explained above, the decision of the tribunal involves an error of law. I therefore allow the appeal by the appellant to the Upper Tribunal. I re-make the tribunal's decision in the terms as set out at the start of this decision.

Signed on the original Nicholas Wikeley

on 23 March 2009 Judge of the Upper Tribunal