Can Benefits Be Stopped for Refusing Medical Treatment?

People receiving benefits because of a health condition may be expected to take reasonable steps towards preparing for or returning to work. However, there is no general rule allowing benefits to be stopped simply because a claimant refuses treatment for obesity, alcohol dependence, drug dependence or another medical condition.

The position depends on the benefit being claimed, the claimant's assessed ability to work and the requirements recorded in their Universal Credit claimant commitment.

Obesity and Addiction Are Health Conditions

Obesity and dependence on alcohol or drugs can have serious physical, psychological and social consequences. They may affect a person's ability to work, travel, manage daily activities or engage reliably with employment support.

These conditions should not automatically be treated as lifestyle choices. Their causes can be complex and may involve physical illness, mental health difficulties, trauma, poverty, prescribed medication, genetics and social circumstances.

Whether someone qualifies for a benefit depends on the relevant legal eligibility rules and the practical effect of their condition, rather than moral judgements about how the condition arose.

Universal Credit and Health Conditions

A claimant receiving Universal Credit must normally accept a claimant commitment. This records the activities they are expected to undertake in return for receiving the benefit.

The commitment must be based on the person's individual circumstances. A work coach should take account of matters including:

■ Physical and mental health conditions
■ Disabilities
■ Caring responsibilities
■ Current earnings
■ Treatment, recovery and rehabilitation needs
■ The claimant's realistic ability to prepare for or obtain work

A claimant who does not complete an agreed work-related activity without a good reason may receive a sanction, reducing part of their Universal Credit payment.

Can Treatment Be Included in a Claimant Commitment?

A claimant commitment is intended to contain reasonable work-related activities. It is not normally a mechanism for forcing a person to undergo medical treatment, take prescribed medication or attend a particular medical procedure.

A work coach may discuss voluntary treatment and can direct a claimant towards available support. Treatment, counselling or rehabilitation may also form part of a wider voluntary plan to improve health and employment prospects.

However, refusing medical treatment is not automatically the same as refusing a lawful work-related requirement. Any decision to impose a sanction must be based on an actual requirement placed on the claimant and whether they had a good reason for failing to comply.

Work Capability Assessments

A person whose illness or disability affects their ability to work may be required to provide fit notes and undergo a Work Capability Assessment.

The assessment considers how the claimant's condition affects their ability to carry out specified activities. It may result in the claimant being placed in one of the following broad categories:

■ Fit for work
■ Having limited capability for work
■ Having limited capability for work and work-related activity

A person found to have limited capability for work and work-related activity will generally not be required to look for work or undertake work-preparation activities.

A person found to have limited capability for work may still be required to take reasonable steps to prepare for employment, but the requirements should reflect their health and limitations.

What Is a Universal Credit Sanction?

A sanction is a reduction in the claimant's Universal Credit standard allowance. It may be imposed where the claimant fails, without a good reason, to meet an agreed work-related requirement.

Examples can include failing to attend a work-focused interview, refusing suitable work or failing to complete an agreed work-search activity.

Before imposing a sanction, the Department for Work and Pensions should consider the claimant's explanation. Illness, a medical emergency, mental health difficulties, treatment commitments, caring responsibilities or a misunderstanding may amount to a good reason, depending on the circumstances.

Housing and child-related elements are generally calculated separately, although a sanction can still create severe financial hardship for the household.

Challenging a Sanction

A claimant who disagrees with a sanction can ask the Department for Work and Pensions for a mandatory reconsideration.

This should usually be requested within one month of the decision. However, a late request may be accepted where there are sufficient reasons for the delay.

If the decision is not changed, the claimant may appeal to the First-tier Tribunal. Relevant evidence may include:

■ Medical records or fit notes
■ Evidence of treatment appointments
■ Letters from support workers
■ Records of communications with the work coach
■ Evidence explaining why the requirement was unreasonable or could not be completed

A claimant experiencing financial hardship during a sanction may be able to apply for a recoverable hardship payment, subject to the relevant conditions.

Personal Independence Payment

Personal Independence Payment, commonly known as PIP, is intended to help with the additional costs associated with a long-term health condition or disability.

PIP is not an unemployment benefit. A person can receive it while working, while receiving other benefits or while having savings.

Entitlement is based on how the condition affects specified daily-living and mobility activities. It is not based solely on the diagnosis or whether the person is receiving treatment.

A claimant may be asked about medication, therapy and other treatment during an assessment because this can provide evidence about the condition. However, refusing treatment does not in itself automatically end entitlement to PIP.

The decision maker may consider why treatment has not been undertaken and whether the claimed difficulties remain consistent with the available evidence.

Drug and Alcohol Dependence

Drug and alcohol dependence may be accompanied by mental health problems, homelessness, family breakdown, debt and physical illness. Recovery can involve repeated attempts and periods of relapse.

A claimant may be offered support through local drug and alcohol treatment services. Jobcentre Plus can also provide information about specialist services and employment support.

Individual Placement and Support programmes aim to help people receiving drug or alcohol treatment obtain paid employment. Participation in treatment or employment support may improve a person's prospects, but treatment must still be clinically appropriate and accessible.

Obesity and Employment

Obesity alone does not automatically establish entitlement to a health-related benefit. The relevant question is how the claimant's condition affects their ability to work or perform the activities considered under the particular benefit.

A person may experience restricted mobility, breathlessness, joint problems, diabetes, cardiovascular illness or mental health difficulties. These effects should be assessed individually.

Support may include weight-management services, physical activity programmes, psychological support, dietary advice or medical treatment. Availability and suitability can vary considerably, and a person should not be assumed to be refusing help where effective treatment is unavailable or inappropriate.

Can Claimants Be Expected to Engage With Employment Support?

A claimant who is capable of some work-related activity may be expected to engage with appropriately tailored employment support.

This could include attending work-focused interviews, discussing suitable employment, preparing a CV, undertaking training or considering adjustments that would make work possible.

The requirement must be reasonable. It should not conflict with medical evidence or require activity beyond the claimant's assessed capability.

Discrimination and Equality

Some long-term conditions associated with obesity or addiction may amount to a disability for the Equality Act 2010 where they have a substantial and long-term adverse effect on normal day-to-day activities.

The precise legal position can be complicated, particularly because certain addictions are treated differently under disability legislation. A separate physical or mental impairment caused by an addiction may nevertheless qualify for protection.

Employers may have a duty to make reasonable adjustments for a disabled employee or job applicant. Examples could include altered duties, changes to working hours, time away for treatment or changes to the working environment.

A Balance Between Support and Responsibility

The benefits system seeks to balance financial support with reasonable steps towards employment where work is realistically possible.

Requiring claimants to engage with suitable employment support may help some people return to work. However, threatening to remove income solely because a person has not recovered from a complex health condition is unlikely to address the reasons they are unable to work.

Treatment may fail, relapse may occur, and waiting lists may prevent timely access to services. Any benefit decision should therefore be based on the legislation, medical evidence and theclaimant'ss individual circumstances rather than assumptions about personal responsibility.

Obtaining advice

A claimant should seek advice promptly where they believe an unreasonable requirement has been included in their claimant commitment, their health limitations have been ignored or a sanction has been imposed incorrectly.

Advice may be available from a Welfare rights adviser, Citizens Advice, a relevant charity or a solicitor experienced in Welfare benefits and public law.

Strict time limits apply to mandatory reconsiderations and benefit appeals, so it is important not to delay.

Important Information

Solicitors.com is not a firm of solicitors. This article is provided for general information only and does not constitute legal, medical or Welfare benefits advice. Benefits rules and government policies may change, and their application will depend on the individual circumstances. You should seek advice from a suitably qualified solicitor, Welfare rights adviser or healthcare professional before taking or refraining from action.