Employers guide to assessing fitness to work, including asking for medical evidence, fit notes, and dealing with long term or frequent absences.
Periods of incapacity for work (PIW) and providing evidence
You must tell your employees what you expect them to give you as evidence of incapacity for Statutory Sick Pay (SSP) purposes and when you expect them to give it. You can’t withhold SSP for late medical evidence as this could be because your employee is unable to get an appointment with their doctor.
Incapacity for 4 to 7 days
You may accept:
- self certification verbally or by letter
- form SC2 for self certification
- your own similar form
Incapacity lasts more than 7 days
You can ask your employee to give you medical evidence or a fit note from their doctor. It is your decision whether evidence of illness is required, and if so, what evidence is acceptable. A doctor’s fit note is strong evidence of sickness and is usually acceptable. Your employee may give you a certificate from someone who is not a doctor, such as:
- Christian Scientists
You decide whether or not to accept them. If you have any doubts you can still ask for a doctor’s fit note.
Your employee must continue to notify you of ongoing sickness. You can withhold payment if there are any days for which you haven’t been notified, but not for late medical evidence.
Doctor’s fit note - statements on fitness for work
Fit notes allow doctors to advise whether:
- an employee shouldn’t work
- it would be appropriate for them to do some work
This gives employers greater flexibility in managing sickness absence. A doctor may provide additional information which will help employers consider basic adjustments which can be made to help someone to return to work.
These are options for you and your employee to discuss and agree. Accept the current fit note as evidence that your employee is unfit for work, if no changes are made.
Precautionary or convalescent reasons
A doctor can advise an employee not to work for precautionary reasons or to convalesce because they suffer from a disease or disablement. The incapacity continues for as long as the doctor states that the employee mustn’t work.
Infectious or contagious diseases
Your employee can be advised not to work by their doctor if they are a carrier of, or have been in contact with, an infectious or contagious disease.
Bereavement is not an incapacity, but the relationship between your employee and the deceased, eg as a parent or partner, could mean that your employee may well be ill. They may be suffering from shock due to the nature of death or depression/anxiety through loss. Take into account the employee’s circumstances and decide whether to accept this as the reason for incapacity. SSP is only payable if you decide that the reason is acceptable.
Common abbreviations used on fit notes
|CAT||coronary artery thrombosis|
|CHD||coronary heart disease|
|COAD||chronic obstructive airways disease|
|D&C||dilation and curettage|
|D&V||diarrhoea and vomiting|
|DS||disseminated (multiple) sclerosis|
|IDK(J)||internal derangement of the knee ( joint)|
|IHD||ischaemic heart disease|
|LIH||left inguinal hernia|
|NAD||no abnormality detected|
|NYD||not yet diagnosed|
|PID||prolapsed intervertebral disc|
|PUO||pyrexia of unknown origin|
|RIH||right inguinal hernia|
|URTI||upper respiratory tract infection|
|UTI||urinary tract infection|
Non-UK medical certificates
Your employee may be provided with a non-UK medical certificate for a period when they were abroad during sick absence. HM Revenue and Customs (HMRC) only arranges translation into English where you disagree with your employee on their SSP entitlement.
Getting medical advice
You decide how to monitor sickness absence, but reducing sickness absence levels can reduce costs and increase output. Repeated short absences for minor illnesses may be masking a more serious problem or a difficulty at work. You may think that an employee who claims to be sick and incapable of work is capable of doing their job and should return to work.
If your employee is often away sick or they’re off for a long time, you may ask for medical advice about their condition. If your employee’s absence lasts longer than expected, you can stop paying SSP, but you must explain your reasons to your employee within 7 days of your decision.
You can also ask for medical advice and continue paying SSP.
If you decide to ask for medical advice, consider one of the following:
- using your own medical adviser
- a report from your employee’s doctor
- the help of Medical Services
Getting medical advice about frequent absences for short periods
If you don’t have access to your own ‘works’ doctor, you can ask HMRC to arrange for your employee to be medically examined by their medical services provider. The report will give an opinion on your employee’s fitness for work in their job with you. This will help you to decide if the employee is incapable of work or not. You can use this service where the employee has been:
- repeatedly off sick for 4 to 7 days in a relatively short period
- sick for 4 or more short periods in a 12 month period
You can do this even after your employee has returned to work.
A report will be sent to HMRC giving an opinion as to whether:
- your employee is incapable of work
- there are reasonable grounds for your employee having frequent absences from work for medical reasons
When HMRC receives the medical report, they will write to you. You won’t be sent a copy of the report as it is given under contract to HMRC by Medical Services and is confidential. It can only be made available to other parties during the course of an appeal hearing when, with written consent from the employee, it is provided as evidence. If requested, the Medical Services’ doctor will attend the appeal hearing to give evidence relating to their report.
Getting medical advice about lengthy absences
When a serious illness or injury is diagnosed, it is unlikely that incapacity for work will be in doubt during the period for which SSP is payable. Illnesses sometimes last longer than expected and a plan that considers what steps should be taken to aid a speedy return to work can be helpful. The following table gives some of the diagnoses commonly given by doctors as the cause of incapacity on medical certificates or fit notes issued by them. Similar illnesses are grouped under one heading, with a suggested time after which you may consider asking for advice. The Department for Work and Pensions (DWP) use similar guidance when considering the control of Employment Support Allowance.
Suggested review periods (in weeks) for common illnesses
|Addiction (drugs or alcohol)||10|
|Anaemia (other than in pregnancy)||4|
|Back and spinal disorders (PID, sciatica, spondylitis)||10|
|Cold, coryza, URTI, influenza, bronchitis||4|
|Debility, cardiac, nervous, post-op, post-partum||10|
|Fractures of lower limbs||10|
|Fractures of upper limbs||10|
|Gastro-enteritis, gastritis, D&V||4|
|Inflammation and swelling||4|
|Joint disorders other than arthritis and rheumatism||10|
|Kidney and bladder disorders, cystitis, UTI||4|
|Menstrual disorders, menorrhagia, D&C||10|
|Mouth and throat disorders||4|
|Peptic, gastric, duodenal ulsers||4|
|Respiratory illness: asthma||10|
|Skin conditions, dermatitis, eczema||10|
|Sprains, strains, bruises||4|
|Wounds, cuts, lacerations, abrasions, burns, blisters, splinters, FB||4|
If your business has its own medical adviser, ask them to give their opinion as to whether the employee is incapable of doing their own job with you or not.
Medical Services has a contract with DWP which allows them to give HMRC advice about your employee’s incapacity for work in connection with the payment of SSP. You must ask your employee to give consent for you to obtain such advice.
An example of written form of consent
Name of employer . . . . . . . . . . . . . . . . . . . . . . . . .
Full name of employee . . . . . . . . . . . . . . . . . . . . .
Full address of employee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I agree that a medical opinion about my incapacity for work may be obtained by you from HMRC in connection with my entitlement to SSP. I agree that my doctor may give relevant medical information to a doctor acting on behalf of HMRC and agree that, if necessary, a doctor acting on behalf of HMRC may medically examine me and send a report in confidence to HMRC.
Employee’s signature . . . . . . . . . . . . . . . . . . . . . . . .
Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Employee refuses to give consent
If your employee refuses to give consent, you must decide what to do next. You may decide that their refusal is sufficient grounds to doubt that the incapacity is genuine and stop paying SSP.
Advice on both lengthy and short absences from Medical Services
You must write to:
National Insurance contributions and Employers Office
HM Revenue and Customs
Explain that you are seeking Medical Services’ help about your employee who has been absent from work for a lengthy period or has taken repeated short absences from work.
Enclose the following:
- your employee’s full name, address, date of birth, gender and National Insurance number
- date the latest period of sickness began and the nature of the illness certified by the doctor
- your employee’s written consent (detailed above)
- copies of any medical certificates or fit notes submitted by your employee over the last 12 months making sure the doctor’s name and address are clear - if not, ask your employee to obtain a new signature and/or address
- your employee’s occupation and main activities involved in doing the job
- reason for requesting an opinion
- outcome of any action already taken by you during the present spell of sickness
- dates of any sick absences of at least 4 days over the past 12 months (details of the past 2 years, if known)
- cause of incapacity given on each occasion
- copies of the 4 or more self-certificates given by the employee
HMRC will forward the case to Medical Services who will:
- ask for a report from your employee’s doctor
- if necessary, ask your employee to attend for an examination
Stopping payment of SSP
If you decide either before or after receiving medical advice, to stop paying SSP to your employee, you should explain your decision to them. They are entitled to a written statement from you and can seek a formal decision on their entitlement to SSP from HMRC.
Below is an example of a letter you can to use to advise your employee that you consider they aren’t entitled to SSP for this reason.
Note: only issue this letter if form SSP1 isn’t appropriate or doesn’t apply.
Example letter to notify your employee that you won’t be paying them SSP
Dear [name of employee]
I am writing to tell you why I cannot pay you Statutory Sick Pay (SSP) for the period from..… to……[insert dates]. You cannot get SSP for these days because…………[insert the reasons].
If you have any questions about why I am not paying you SSP please contact me. If you do not agree with my decision not to pay you SSP, you can ask HMRC to make a formal decision. You should phone the SP Disputes Team on Telephone: 03000 560630.
Back to work action plans
Back to work action planning is successful in returning people to work, particularly when used early during long term sickness absence. Evidence shows that people are more likely to get back to work when they talk to their employers during periods of sickness and make plans for returning to work. These plans can be a powerful tool in helping people get back to work quickly when they become ill. Their purpose is to guide a discussion and set a framework for actions to consider when an employee has been absent from work for between 4 to 6 weeks. It provides a snapshot of information at a particular time and is open to regular review.
Fit for Work has more information on managing sickness absence and a return to work.
If you agree a phased return to work or altered hours after a period of sickness, pay SSP for the days that your employee is sick in the normal way. Any day for which SSP is paid will count towards the maximum entitlement of 28 weeks. Your employee’s absence must form a PIW before SSP is paid.