Sep 102014

In less than 2 months time, a new occupational service called Health and Work Service will be introduced in the UK run by a private company, in order to ‘help employees on sick leave to return to work’. This will be done through an occupational health assessment when they reach or are expected to reach more than 4 weeks of sickness absence.

After four weeks, employees will be referred by their GP for an assessment by an occupational health professional, who will look at the all the issues preventing them from returning to work. Following this assessment, employees will receive a return to work plan containing recommendations to help them to return to work more quickly, and information on how to access appropriate interventions.

Given that the referral volumes anticipated are in the region of 350,000 to 700,000 per annum , of which between 5 per cent and 10 per cent are expected to require a face-to-face assessment, it means that the majority of employees will be assessed by telephone. This assessment will not only look at health issues in the workplace but also at non health and non work issues. So the advice given will not just be health related.

There will also apparently be tailored support for the employees through case management. The package is supposed to be agreed between the employee and the private company and failure to cooperate with the service will mean the employee will lose their sick pay.

There are many issues with this scheme which have already been debated in the House of Commons, notably the removal of the percentage threshold scheme, and others which are likely to emerge once it is implemented, but one which did not receive as much publicity as it should have is the tender winner, Health Management Ltd which is a subsidiary of the American multinational Maximus.

Maximus operates in many countries, and it shares the particular distinction with UNUM (the architect of the Welfare reform in the UK, which has close contact with 2 of the authors of a report on which this new Health and Work Service is based, namely Dame Black and Kim Burton) of ‘improper benefit denial’ (in addition to insufficiently trained contractor staff, delays in application processing, etc.). But what looks like a repeat of the Atos disaster is much more sinister. It seems that Maximus not only denies sickness benefits to people who are entitled to them, but also worker compensation and treatment. The following letter is addressed by Maximus to an US employee who made a compensation claim against her employer. Not only was her claim dismissed, but all the medication she took to manage the pain were deemed ‘not medically necessary and appropriate’, meaning she could no longer get her medication on prescription.

Will Maximus behave or be allowed to behave in the same way in the UK?

Sample IMR Determination (Upheld Denial) Letter, Page 1

Sample IMR Determination (Upheld Denial) Letter, Page 2Sample IMR Determination (Upheld Denial) Letter, Page 3Sample IMR Determination (Upheld Denial) Letter, Page 4Sample IMR Determination (Upheld Denial) Letter, Page 5

By Anita Bellows, with thanks to assistance of George Berger


[suffusion-the-author display='description']
 Posted by at 22:03

  8 Responses to “Maximus, the private provider which not only denies benefits but also treatment”

  1. so basically, they are going to be stopping meds, which so far have kept a condition from getting worse.. just because it doesn’t say its helping on your notes…………. ARE THESE PEOPLE THICK? IF IT DON’T SAY ITS HELPING YET YOUR STILL BEING PRESCRIBED IT THEN IT MUST BE HELPING…. and in the case of Omeprazole/lansoprazole etc… these are probably preventing a stomach heamorhage……….. they have basically found another way to kill us………. but..its against the law to withhold meds, if doing so means someone will die, without 2 (may be more?) specialists decide,along with the family of a patient, who is (for instance) comatose and has been for a long while.or whose quality of life will be just a vegetative state if they do come out of it.(saw this once only when i was nursing over 45 yrs ago. young man/. car accident. in coma 2yrs. eventually they stopped feeding him by tube. and let him die.even now i wonder if was right thing. miracles do happen after all but was not in my hands.

  2. So GPs will find the time to write referrals but claim that writing in support of benefit claims is too much of an imposition and refuse?

    Interesting. And hypocritical.

    Or are they being paid for this?

  3. The new “Health and Work Service” run by Maximus will not be introduced in the UK! It will be introduced in England and Wales, but not in Scotland.

    The Scottish Government has already rejected this privatised part of the NHS – even without Independence!

  4. David Hencke has written about this as well in 2 columns

    In the Tribune – “Multinational takes charge of sick pay eligibility” –

    On his own blog – “Coming Soon: The privatised sick note service that will email you back to work” –

    An example of how Maximus processes claims in the US –

 Leave a Reply

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>



For security, use of Google's reCAPTCHA service is required which is subject to the Google Privacy Policy and Terms of Use.

I agree to these terms.