ATOS-Full Personal Liability Form

Fill-in-the-boxes Templates that can be used to rebut a Summons or any Charge or Demand based on Statutes.

ATOS-Full Personal Liability Form

Postby MikeThomas » Fri Jul 13, 2012 9:12 am

This template is provided by one of our members 'idolcom' and he has given permission for any other member of this site to use it should they be called in for a medical assessment by ATOS.



Name of ATOS Health Care Professional: ________________________________
Your Personal Address: ______________________________________________
_________________________________________________________________
Are You A Doctor/Nurse/ Other Health Care Professional?_____________________
Professional Body Registering the H C Professional:__________________________
Professional Registration to Practice Number: ______________________________
Do You Have Proof of Qualifications? Yes/ No
If No Please Give Explanation Why Not: ___________________________________

___________________________________________________________________
Have You Got the Proof on Site? Yes /NO
If No Please Give Explanation Why Not:___________________________________

___________________________________________________________________
Name of University /Medical School:______________________________________
___________________________________________________________________
Description of Your Degree:_____________________________________________
Year of Qualification: __________________________________________________
Was Your Medical / Nursing or other health care Degree Validated By The BMA/ RCN or other healthcare body?: Yes/ No
If NO Please Give Explanation:__________________________________________
___________________________________________________________________
What Is Your Medical Speciality?_________________________________________
Have You Taken Further Study and Examinations In Your Speciality? Yes /No
If Yes Please State Nature of Further Training: _____________________________
___________________________________________________________________
Do You Have Personal Unlimited Liability Professional Indemnity Bond? Yes /No

You Agree To Have Personal Unlimited Liability: Yes/ No
If No Please State Your Reasons:_______________________________________

___________________________________________________________________
Personal Professional Indemnity Bond Number:
Name of Your Insurance Company:_______________________________________
Insurance Company Address:___________________________________________
___________________________________________________________________
I confirm the above questionnaire was provided and the information given by me is The Truth, The Whole Truth and Nothing But The Truth, under penalty of perjury for my personal unlimited liability and that of my employer ATOS Health Care.
Signed by Health Care Professional:___________________________________
Date: ___________________________________________________________

1st Witness Signature:_____________________________________________
Witnessed by: ___________________________________________________
Address:________________________________________________________
_______________________________________________________________
Date: ___________________________________________________________
2nd Witness Signature:______________________________________________
Witnessed by: ____________________________________________________
Address: _________________________________________________________
_________________________________________________________________
Date:_____________________________________________________________



He used this recently and the Health CARE PROFESSIONAL DIDN'T EVEN EXAMINE HIM AS SHE REFUSED TO SIGN IT! A few weeks later he got a letter from the DWP informing him that his claim would continue :yes: Here's a download link for the complete form.
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Re: ATOS-Full Personal Liability Form

Postby frogmanbrabs » Fri Jul 13, 2012 10:46 am

I went along to one of these in May and I wasn't examined just asked questions. One month later my ESA claim was stopped and the letter read "after being examined". I have disputed this but the claim has been turned down.
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Re: ATOS-Full Personal Liability Form

Postby MikeThomas » Fri Jul 13, 2012 12:57 pm

Sorry to hear that Frogmanbarbs. Currently the Guberment are on an austerity kick perhaps because they are expecting to ask for a bailout from the IMF. It's always the same old story whichever Guberment is in power.

First they demonise the poorest in society and get the middle classes to kick us when we're down. Then they apply the same bollox to the middle classes who find they can't complain about it as they agreed to it!

Meanwhile, all the Guberments rich friends and bankers are allowed to rob everybody blind while collecting huge bonus' for something that (if you or I did it) would land us in prison.

But lets not moan about it! After all "Equality beneath the law is paramount", isn't it? :thinks:

Its the rich what gets the gravy and the poor what gets the blame! And the middle classes are going to be paying for it!
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Re: ATOS-Full Personal Liability Form

Postby frogmanbrabs » Fri Jul 13, 2012 6:18 pm

An Open Mind can take you on a journey to anywhere.
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Re: ATOS-Full Personal Liability Form

Postby musashi » Sat Jul 14, 2012 10:16 pm

frogmanbrabs wrote:I went along to one of these in May and I wasn't examined just asked questions. One month later my ESA claim was stopped and the letter read "after being examined". I have disputed this but the claim has been turned down.


Fraud Act 2000 could be a friend here.

Cheers for the document. A very nice piece of work!
Musashi
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Re: ATOS-Full Personal Liability Form

Postby idmolcom » Mon Jul 30, 2012 9:48 pm

musashi wrote:
frogmanbrabs wrote:I went along to one of these in May and I wasn't examined just asked questions. One month later my ESA claim was stopped and the letter read "after being examined". I have disputed this but the claim has been turned down.


Fraud Act 2000 could be a friend here.

Cheers for the document. A very nice piece of work!
Musashi


Hey Musashi,

You know the clown who wrote to you in your turn down notice,
get his name and we can sue him privately under a commercial
lien.

We could start off at say conservatively £5K ending up with
circa £5 million.

If you wish to go down that route give me a buzz and I will set
it up for you.

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Re: ATOS-Full Personal Liability Form

Postby Too Far Gone » Wed Apr 17, 2013 11:52 am

Hi idmolcom

I've just got an ATOS appointment. Well, they've asked me to fill in the forms so they can make me an appointment. I have downloaded this document (looks awesome) and was wondering if there's any advice to go with it before I fill in their form. Also, if you don't mind I'm going to pass this along to others if it works out well for me.


Thanks for the template


TFG.
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Re: ATOS-Full Personal Liability Form

Postby musashi » Wed Apr 17, 2013 4:24 pm

idmolcom wrote:
musashi wrote:
frogmanbrabs wrote:I went along to one of these in May and I wasn't examined just asked questions. One month later my ESA claim was stopped and the letter read "after being examined". I have disputed this but the claim has been turned down.


Fraud Act 2000 could be a friend here.

Cheers for the document. A very nice piece of work!
Musashi


Hey Musashi,

You know the clown who wrote to you in your turn down notice,
get his name and we can sue him privately under a commercial
lien.

We could start off at say conservatively £5K ending up with
circa £5 million.

If you wish to go down that route give me a buzz and I will set
it up for you.

idmolcom


You got me mixed up with the other guy. I have not been sent a "turn down" letter. He has. And before anyone thinks about a lien they should get a definition - from ATOS or whoever sent the letter - of the word "EXAMINED". That definition may supprt a claim of tort - but it may not.

Also, before anyone thinks about a lien - a tort must have been committed to justify one - a criminal complaint must be pursued before a private one. Public good comes first - unless you are in a contract, in which case there is no tort, just a contractual default. So, if the Fraud Act is applicable, then a public complaint is the first step.

Who made the decision in this case, (I think they employ their own doctors) on what grounds and what is the appeal process? Ask for a date of the EXAMINATION. You were not there, perhaps, so how can you know if one took place? An examination may come, as it does in schools, in simple question form.

A lien is a money claim, and if you make an unsubstantiated and unprovable claim you will lay yourself open to counter claim for money.

Musashi
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Re: ATOS-Full Personal Liability Form

Postby Too Far Gone » Fri Apr 19, 2013 10:17 pm

I can't seem to get hold of the guy who created the form so i'd like to ask the community a couple of questions:

Do i have the right to see the healthcarers qualifications and everything listed in this form?
Where can I get hold of the legislation that enables me to request this information?

Thanks guys n gals.
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