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EPN379 - Scheme Medical Adviser - Referral Processes

Audience

This notice will be of interest to:

  • Staff responsible for Scheme Medical Adviser (SMA) referrals.

Action

  • Note the changes to processes and take the required action.

Timing: Immediate

  1. Background


    Following the award of the SMA contract to Capita Health and Wellbeing (CHW) effective from 1 July 2013 a number of procedural issues have been brought to our attention that are not covered by the framework agreement. This EPN clarifies the practices and processes for employers to follow in certain situations.
  2. Failure of member to attend a medical appeal board or cancellation at short notice

    If a member fails to attend an arranged medical appeal board CHW will:
     - rearrange the board, if the member still wishes to continue with their application;

    - charge the referrer their standard fee for the unattended/cancelled board;

    - if the member fails to attend the second board or cancels at short notice the board will make an ’in absentia’ decision based on the paper evidence and the referrer will be charged.

    This process has been put in place to recognise the effort and costs involved in the setting up of appeal boards and to prevent problems in arranging boards and recruiting board members. Non-attendance at boards is a relatively uncommon event but it is necessary to have this process in place.
  3. CHW receives relevant information after they have produced an Outcome Report
    If they receive the new evidence before the case is closed CHW will look at the new information. This may result in CHW rewriting their report at a charge of £104. CHW cannot ignore relevant evidence and the charge reflects the additional work to rewrite the report.
  4. Medical advice in injury benefit cases where there is a lack of evidence
    CHW may ask an injury benefit applicant’s doctor for a report so they can give advice on whether their injury qualifies. If the doctor fails to give a report and CHW have no other reasonable medical evidence they will return the case to the referrer saying ‘we cannot provide advice because of a lack of evidence.’ It is the referrer’s responsibility to explain the outcome to the member and that they are now responsible for providing medical evidence to support their claim. CHW are taking this approach to close off any potential challenge by stating the applicant has not satisfied the burden of proof. It is also consistent with the line taken when processing ill health retirement applications.
  5. Making Ill Health Retirement (IHR) applications to CHW too early
    IHR may be appropriate when a member’s health affects their work attendance. In some cases departmental occupational health advisors may recommend reasonable adjustments to the member’s workplace to help them remain in work. Until employers have implemented and tested the reasonable
    adjustments they should not make an IHR application. Employers may decide 0the reasonable adjustments are impracticable and have not been tried. In such cases employers must explain why the reasonable adjustments are considered impracticable in the IHR application. IHR applications submitted before the reasonable adjustments have been tested can be delayed because of this. This could also lead to medical retirement certificates being wrongly issued.
  6. Change to the consent form and the Injury Benefit order form CSIBS1
    An extra paragraph has been added to the referral forms IHR1, IHR2, EPPA1, APP1, CSIBS2 and to Medical Consent Form 2. This asks members to consent to CHW retaining any medical information and to agree for it to be used in the future. Members will need to put a cross in the box to give their consent and also sign the form at this point.
  7. The CSIBS1 order form definition of current pensionable earnings has been amended to reflect the CSIBS rules, which refer to ‘earnings capacity’ being impaired. If a member was working part time through choice before an injury occurred, the amount they were capable of earning will be the full time equivalent rate including any pensionable allowances.
  8. On-line Portal
    CHW have been working on an on-line Portal to allow PCSPS employers to submit and track cases electronically. The SMA user group were given a demonstration of the system on 29 October 2013. This raised a number of questions around security accreditation and compatibility with current HR Shared Service systems, which CHW and TPSE have been working to address. It has become apparent that the Portal, as developed, will not be viable for the employers who make the most submissions. TPSE have decided not to pursue this option any further but to explore the possibility of an alternative approach through Government Digital Services.
  9. General Reminder
    Please note employers should give CHW up to date contacts for invoice queries. Updates should be sent to matthew.archer@capita.co.uk. Please note the settlement terms for invoices, are within 10 days of receipt of a valid invoice. Employers who have invoice queries, need case updates or need to escalate issues can contact:

    Invoice queries CreditControl.Colchester@capita.co.uk.
    Case updates referralsihr@capita.co.uk
    Escalation Peter Firmo email peter.firmo@capita.co.uk

    Please ensure all cases are referred with a valid Purchase Order (PO) number, and that the referrer’s name is always shown. Cases will not be accepted without a valid PO. All queries should be raised within 7 days of receipt of the invoice, to the above email address. Invoices will be raised with the information as requested by the referrer e.g. Case reference, Client name etc.

Contacts

If you have a question about the distribution of EPNs or you need to receive them in a different format contact employerpensionnotice@cabinet-office.gsi.gov.uk.

You can find electronic copies of the Employers’ Pension Guide, all current EPNs and forms on our website.

This notice is for employers and should not be issued to scheme members.

If members have a question about their pension they can find information on:

  • the Civil Service pensions website or
  • by contacting your Pension Service Centre.