Disability Impact Statement

A disability impact statement explains:

• the claimant’s physical or mental impairment;
• how long it has lasted or is expected to last;
• how it affects normal day-to-day activities; and
• how those effects would be without medication, treatment or other measures.
  
  
  

It helps the Employment Tribunal decide whether the claimant was disabled under section 6 of the Equality Act 2010 at the relevant time.

The statement should not assess the effects only when they are controlled by medication or treatment. It should explain, so far as possible, what the effects would be without those measures.

The statement should focus on the practical effects of the condition. It is not the same as a witness statement dealing with the whole case.

Disability status

Generally, a person is disabled under the Equality Act 2010 if they have:

1. a physical or mental impairment;
2. which has a substantial adverse effect;
3. on their ability to carry out normal day-to-day activities; and
4. which is long term.

“Substantial” means more than minor or trivial.

“Long term” generally means that the effect:

• has lasted at least 12 months;
• is likely to last at least 12 months; or
• is likely to last for the rest of the person’s life.
•  

Recurring or fluctuating conditions may qualify if the substantial adverse effect is likely to recur.

Template - Disability Impact Statement

IN THE EMPLOYMENT TRIBUNAL

Case number: [Case Number]

BETWEEN

[Claimant’s Full Name]

Claimant

-and-

[Respondent’s Correct Legal Name]

Respondent

DISABILITY IMPACT STATEMENT OF [CLAIMANT’S FULL NAME]

Introduction

1. My name is [Full Name]. I am the claimant in these proceedings.
2. I make this statement to explain the effect of my [physical/mental] health condition, [Name of Condition], on my normal day-to-day activities.
3. The relevant period for my claim is [Dates]. The effects described below relate particularly to that period.

The impairment

1. I first experienced symptoms in approximately [Month and Year].
2. My symptoms include [briefly list the principal symptoms].
3. I was diagnosed with [Condition] by [GP/Consultant/Other Professional] on or around [Date]. The relevant medical evidence appears at pages [Bundle Pages], if applicable.
4. If no formal diagnosis was made at the relevant time, explain why but describe symptoms and effects

Duration

1. The condition and its effects began in approximately [Date].
2. At the relevant time, they had lasted for [Period] and were expected to continue for [Period].
3. The condition is [continuing/recurring/fluctuating]. If it fluctuates, explain how often symptoms occur and how long they usually last

Effect on normal day-to-day activities

1. The condition affects the following activities.

Mobility

1. [For example: I can walk for approximately ten minutes before needing to stop because of pain. Before the condition, I could walk for about an hour without stopping.]

Standing and sitting

1. [For example: I cannot stand for longer than approximately 15 minutes without significant discomfort. I need to change position regularly when sitting.]

Lifting, carrying and using my hands

1. [For example: I have difficulty carrying shopping, opening jars, typing or fastening buttons.]

Personal care and household tasks

1. [For example: Washing, dressing, cooking and cleaning take longer. On particularly difficult days, I need help from [Person].]

Sleeping

1. [For example: Pain or anxiety interrupts my sleep approximately four nights each week. This causes fatigue the following day.]

Concentration and memory

1. [For example: I have difficulty concentrating for more than 20 minutes and may need written instructions or reminders.]

Communication and social interaction

1. [For example: During periods of anxiety, I find telephone calls, meetings or unfamiliar social situations difficult.]

Travelling

1. [For example: I avoid public transport at busy times because [explain]. I require additional time or assistance when travelling.]
2. [Add any other relevant normal day-to-day activity.]

Frequency and severity

1. On a typical day, [describe the usual effects].
2. On a particularly difficult day, [describe the more serious effects].
3. I experience particularly difficult days approximately [Number] times each [week/month].
4. The activities described above take me [longer/how much longer] than they did before the condition began.

Medication, treatment and coping measures

1. I take the following medication or receive the following treatment: LIST MEDICATION
2. Medication or treatment reduces my symptoms by [explain].
3. Even with medication or treatment, I continue to experience [describe remaining effects].
4. Without medication, treatment, assistance or coping measures, I believe the effects would be [describe the likely effects and explain the basis for that belief].
5. I also manage the condition by [for example, avoiding certain activities, taking breaks, using equipment, following routines or receiving help from another person].

Effect at work

1. At work, the condition affected my ability to [describe relevant tasks or activities].
2. I experienced difficulty with [for example, standing, travelling, concentrating, working particular hours or using equipment].
3. I used or requested the following support or adjustments: [Describe].
4. The effect at work is included to help explain the condition. My difficulties were not limited to work and also affected the normal day-to-day activities described above.

Respondent’s Knowledge

1. I informed [Name and Job Title] about my condition on [Date] by [email/meeting/telephone].
2. I provided the following information or documents: [Describe].
3. The respondent also became aware of the condition through [sickness absence records, occupational health reports, fit notes or another source].

Supporting evidence

1. I rely upon the following supporting material:

• medical records dated [Dates];
• fit notes dated [Dates];
• occupational health reports dated [Dates];
• prescription records;

Statement of truth

I believe that the facts stated in this disability impact statement are true.

Signed: __________________________

Name: [Claimant’s Full Name]

Dated: [Date]

Next Steps

Valla knows it can seem quite overwhelming, but Valla can help. We have a team of legal experts who are very used to working with users to draft impact statements and a document review service that you check any tribunal documents that you generate. 

How to submit: 

When your document is ready you will be required to send it to the Respondent/their solicitor (and in accordance with any directions from the Tribunal) and enclose all relevant medical information and evidence including GP records, clinical records and correspondence with any treating specialists.  Sign up for your free account.