This is the part you complete and sign (as relevant).
Your Details
This section asks for confirmation of your details – to verify that those held on your employer’s records are accurate and up-to-date.
You are also asked:
- To describe why you are not able to work in your usual job;
- To explain any barriers to your working in your usual job;
- If you could you do any other work, and if so what; and
- Why you believe you will not be able to return to work before your scheme pension age.
This information will help the Scheme Medical Adviser consider your application. It relates to the impact of your medical condition rather than the condition itself. It is important to the pension assessment as it is the type of information that is not generally covered in a GP or specialist report.
Please note:
An explanation of the meaning of particular terms mentioned above is given in Annex A below.
Medical Consent Form 1
You should complete and sign this form to give permission for the Scheme Medical Adviser to see appropriate medical information about your condition to complete an ill health retirement assessment. See the further information below about using the Medical Information Consent Forms (lettered ‘a’, ‘b’ and ‘c’).
Medical Consent Form 2
This form gives an explanation of what happens to the report that the Scheme Medical Adviser produce after they have completed their assessment of your medical condition. You should complete and sign the relevant boxes on this form:
- to give consent for the Scheme Medical Adviser to send the outcome report of your medical assessment to your employer once it is completed and;
- to confirm if you wish to see a copy of the report before it is sent to your employer.
The main reason for giving you the option of seeing a copy of the report before it is sent to your employer is to provide an opportunity for you to correct any factual errors in the report. See ‘Correcting Factual Errors in the Scheme Medical Adviser’s report’ for more information.
Important note:
It is unlikely to be in your best interests to withdraw consent for the Scheme Medical Adviser to send their assessment report to your employer.
Without a report and certificate:
- your employer cannot offer ill health retirement and can proceed to take other action (e.g. dismissal for inefficiency, if they intended to take such action), having first considered the appropriateness of ill health retirement;
- it will be taken that you have stopped the ill health retirement process;
- you will not be able to appeal against the Scheme Medical Adviser’s medical assessment.
See below for more information about what to do if you disagree with what the Scheme Medical Adviser has written in their report. Also see below for information about what routes are available if you have a query or complaint about other aspects of the handling of your application for a medical assessment.
Medical Information Consent Forms (A, B and C)
If you give your permission on Consent Form 1 for the Scheme Medical Adviser to see appropriate medical information about your condition, you must complete and sign a separate Medical Information Consent Form for each medical practitioner you would be prepared for them to contact. This will allow the Scheme Medical Adviser to provide evidence to your doctor or specialist(s) (or all) that you have given permission for them to give appropriate medical information about your condition to the Scheme Medical Adviser to support your application. Three forms are provided in case you want to allow them to contact more than one medical practitioner about your condition, but you do not need to complete every form.
Optional Form and Notes – for your doctor or specialist
The Scheme Medical Adviser is responsible for obtaining appropriate medical information about your condition in the first instance (with your permission), but any current medical evidence (i.e. typically under three months old), you can provide or pursue directly, such as a report from your doctor or specialist. This may enable them to complete your assessment more quickly.
If you decide to obtain a report from your doctor or specialist yourself to support your application for ill health retirement, the ‘Optional Form and Notes’ provides details of the kind of information your doctor or specialist would need to give about your condition. They can chose to complete the form or to provide a separate report that fulfils the criteria outlined on the form to enable the Scheme Medical Adviser to reasonably assess your case.
Brief guidance on how applications are considered has been given at the end of the form as it may help your doctor or specialist provide the necessary information. You must make sure you return the form to your employer promptly. They will let you know of any deadline that applies. If your doctor or specialist would prefer an electronic version of this form please let your employer know. When the form is completed your doctor should enclose it in a sealed envelope clearly marked with your name and stating that it contains medical in confidence information to be opened only by Health management Limited.
Please note:
It is important that any medical information provided by your doctor or specialist is legible – typed reports are preferable. Statements must be supported by first hand evidence from examining practitioners and/or objective testing. Complete documents must be submitted. Extracts from clinical notes or reports are not acceptable