Thousands of people applying for sickness benefit could be ordered to get a job instead, under proposals unveiled by the Government yesterday.
And one in six of the 49,500 people already on sickness benefit in Birmingham could eventually have it taken away from them.
Work and Pensions Secretary Peter Hain announced details of a new test for claimants, to end what the Government called "sick-note Britain". He said it would focus on the type of work that people can do, instead of the disabilities they have.
For example, claimants will no longer score points simply because they are unable to walk more than 400 metres.
Instead the new test might look at their ability to use a computer keyboard or a mouse - skills which could be useful in the workplace.
The test will be used for people who apply for sickness benefit from October 2008, when the new Employment and Support Allowance is introduced.
Around six out of 10 of those who apply for incapacity benefit currently receive it, but that will fall to five out of 10 under the new system.
Officially, the Government says it has not yet decided whether to include the 2.64 million people currently claiming incapacity benefits, at a cost of £12.5 billion a year.
They include 11,900 people in Dudley, 15,100 people in Sandwell, 6,180 people in Solihull and 11,960 people in Walsall.
But Ministers are widely expected to force existing claimants to take the new test within the next few years. Around one in six of existing claimants could fail. It was revealed yesterday that almost 2,000 people across Britain have been claiming the benefit, on the basis that they are too fat to go to work.
The Government said the change in the rules would lead to 20,000 fewer people each year successfully claiming sickness benefits.
But Conservatives said that it would take decades for the Government to reach its target of getting a million people off sickness benefits.
Chris Grayling, the shadow work and pensions secretary, said: "This is at least the fifth time the Government has made this announcement, but the reality is that it is completely missing its targets." Mr Hain said people legitimately unable to work would still receive benefits under the new system.
He said: "We are not talking about closing a door - we are saying we will open the door to new skills, support and confidence building.
"We know that many people want to work. Work is good for you and your long-term well-being and we don't think it's right that in the past people were effectively written off. We want to work with people to get them back into jobs and help them stay there."
Guy Parckar, policy manager for Leonard Cheshire Disability, which supports more than 21,000 disabled people in the UK, said: "Making the new test even tougher will mean that fewer people will receive the higher levels of support which could help them to find a new job."
TUC general secretary Brendan Barber said: "The Government must get people back to work through access to rehabilitation and support. Government pilots, such as Pathways To Work, have shown that this is the most effective approach."