Ill Health Retirement - Guide for Members

As a result of the Coronavirus, the Scheme Medical Advisor (SMA) has advised that it has put contingency plans in place to ensure minimal disruption to services. This includes working from home for clinical and SMA administration teams.

Due to the unprecedented demands on the NHS, there may be delays in processing applications where it is not possible to obtain information from GPs and specialists. Additional delays may also occur if Government legislation is introduced that redirects healthcare providers to assist NHS activities.

Read more about the Scheme Medical Advisor's service during the Coronavirus pandemic. 

You should note this guide does not cover all aspects of the ill health retirement procedure or your employer’s responsibilities. It also does not override pension scheme rules. If there is a difference between any aspect of this guidance or the scheme rules, the scheme rules will apply.

Ill health retirement should be a last resort and when you have health problems the expectation is you should seek the necessary treatment. When a medical condition is severe enough to warrant ill health retirement, it is generally expected that you will have had the benefit of a specialist opinion during your illness.

For more information and timescales, see the what to expect guide.

In general, members of classic, classic plus, premium, partnership or nuvos, must have at least 2 years’ qualifying service and have suffered a permanent breakdown in health involving incapacity for employment. In this context ‘permanent’ normally means until you reach scheme pension age.

a. classic – the criteria for ill health retirement in classic are that an individual is prevented by ill health from discharging his or her duties and that the ill health is likely to be permanent.

b. classic plus, premium and nuvos – there are two levels, or tiers, of ill health retirement. The tier given depends on the effect of the incapacity on your ability to carry out work. If they are unable to decide which of the criteria is met, the Scheme Medical Adviser can recommend a provisional pension benefit at the rate most appropriate at the time.

• Upper tier level: An individual has suffered a permanent breakdown in health and the resulting incapacity prevents them from discharging their own job and of undertaking any other gainful employment.
• Lower tier level: An individual has suffered a permanent breakdown in health and the resulting incapacity prevents them from discharging their own job or a comparable job.

c. partnership – If you have a partnership pension account, you may receive ill health retirement benefits if the Scheme Medical Adviser assesses that your breakdown in health is permanent and that you are incapable of doing your own or a comparable job (this is similar to the premium and nuvos lower tier ill health retirement criteria – see above).

All ill health retirement assessments must be done by the Scheme Medical Adviser.

The Scheme Medical Adviser is the sole provider of advice on access to medical-related Civil Service Pension Scheme benefits.

The current provider is Health management Limited.

You can ask for ill health retirement if you have to leave your job early because you are ill, as long as you are a member of a Civil Service Pension Scheme and meet your scheme’s ill health retirement qualifying conditions.

Your employer can also put you forward for ill health retirement and should do so if they intend to dismiss you for inefficiency due to poor performance or attendance and either they, or you, consider that the causes of this may make ill health retirement appropriate. They must tell you if they intend to refer you for ill health retirement and must also tell you of your right to apply for it. (See the Civil Service Management Code (CSMC), 2009)

Before starting the application process, your employer must first investigate, with support and advice from their occupational health (OH) provider, ways of helping you return to, or stay in work.

For an application to be supported it is necessary to demonstrate that you not only have a medical condition that means you are unable to do your job or a comparable job. You also need to demonstrate that, despite appropriate treatment, the resulting incapacity is likely to be permanent. In other words both the ill health and the incapacity must be likely to be present until your scheme pension age.

If you, or your employer, wish to start the application process, your employer will ask you to complete an application form for an ill health retirement medical assessment. You may be given the whole form and asked to complete the relevant ‘member’ part and return it to your employer. Alternatively, you may just be given the relevant ‘member’ part to complete and return to your employer for them to incorporate with the rest of the form – your employer may decide to separate the parts of the form to speed up the application process.

A summary of the contents of each part of the order form and the evidence required by the Scheme Medical Adviser to complete an ill health retirement assessment are given.

A copy of the current form can be downloaded from the employer forms page.

Overview.

The IHR form is in two parts. Part 1 is for you to complete and sign (as relevant) and Part 2 is for your employer to fill in.

We have seperated them out below.

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:

This part is for your employer to complete 

This part asks for confirmation of your employer’s details to enable the Scheme Medical Adviser to process the application. It also asks for confirmation of your name and contact details (as your employer has on record) and which pension scheme you are in (or when you joined the scheme if you are in partnership). It asks your employer to provide occupational information relevant to your application:

• details of consideration given to job modifications and redeployment – (if redeployment has not been considered your employer should do this before submitting an application for ill health retirement);
• Full Job Description
• Sickness absences during last 5 years
• Occupational Health Records – see below
• Copies of any scheme medical adviser correspondence relating to your case.

Your employer’s Occupational Health Provider (OHP) will need to provide information to enable the Scheme Medical Adviser to reasonably assess your case. Such information will be contained in a ‘Medical in Confidence’ envelope that can only be opened by a medical professional such as the Scheme Medical Adviser with your permission (as requested on Medical Consent Form 1).

The completed IHR form along with occupational and medical evidence must be forwarded by your employer to the Scheme Medical Adviser.

If at any stage in the ill health retirement process you are told you have a terminal illness and that your life expectancy is less than twelve months, you must tell your employer or MyCSP as quickly as possible. They will tell the medical adviser straight away so that the ill health retirement certificate is issued urgently.

Please note:

There are some exceptional circumstances in which an ill health retirement assessment may be allowed to continue, or carried out retrospectively, if your employment is terminated before the ill health retirement assessment has been completed (see ‘What happens if my employment is terminated before an ill health retirement assessment has been completed?’).

An ill health retirement referral can be refused or stopped in certain circumstances, for instance, if you are under investigation for alleged misconduct that could lead to your dismissal. In most cases a decision on ill health retirement will be deferred until the investigation has been completed and then only progressed if you have not been dismissed for misconduct. 

An ill health retirement application can also be rejected by your employer if you should refuse or withdraw consent for the Scheme Medical Adviser to issue the report and certificate to your employer confirming the outcome decision of your ill health retirement assessment. See ‘Withdrawing consent for the Scheme Medical Adviser to send their report to your employer’

Your employer should not normally terminate your employment while an ill health retirement assessment is on-going and the outcome has not been confirmed. 

However, there may be occasions when such action has been taken in error – either through:

• a misunderstanding of the circumstances or procedures;
• because your employment has been transferred out of the Civil Service as part of a departmental closure, or Machinery of Government change before your ill health retirement assessment has been completed;

• your employer was running an early exit scheme and believed that you should have the option of taking redundancy by an agreed deadline, in case your ill health retirement application was unsuccessful. Your employer may not have realised that it should be possible to reach separate agreement on early exit departure dates until the outcome of your ill health retirement application is confirmed.

If your employer has taken such action in error, then your application should be allowed to continue, or carried out retrospectively. Your employer may need authorisation from the Scheme Administrator to confirm for the Scheme Medical Adviser, that your assessment can continue, or be carried out retrospectively. Retrospective ill health retirement will apply from the last date of service if your employer decides that they should have granted medical retirement at that date.

In limited circumstances, you may be allowed to apply for ill health retirement retrospectively. Retrospective ill health retirement is not the same as Early Payment of a Preserved Pension (EPPA) - see below for more information. Retrospective ill health retirement may be allowed in exceptional circumstances – usually when there has been an error in the original handling of your case. For example:

• your employer dismisses you for inefficiency because of poor health, without first considering ill health retirement; or
• you resign or take redundancy because of poor health, but you did not know that you could have applied for ill health retirement.

In either case, there generally needs to have been some indication that:

• you were ill at the time you left;
• your ill health affected your performance or attendance and;
• your employer was aware of your health issues.

Please note:

In the above circumstances, your employer should have considered the appropriateness of ill health retirement or told you of your right to apply for ill health retirement, before you left. Not doing so would usually give grounds to allow a retrospective application.

If you believe that you meet the conditions set out above, you should contact your employer, explaining the background and justification for your request. Your employer will need to ask the Scheme Manager for approval to refer your retrospective application to the Scheme Medical Adviser. The Scheme Medical Adviser will not be able to consider any application without approval.

No, you will not be eligible to apply for ill health retirement if you have already left your employment and the CSPS, except in exceptional circumstances mentioned above.

If you left the Civil Service with preserved classic benefits and your health breaks down after leaving, you can apply for your pension early on ill health grounds. See below for more information about ‘Early Payment of Preserved Pension (EPPA).

Please note:

If you leave your employment and have preserved pension in any CSPS scheme and you are diagnosed as terminally ill with a medically assessed life expectancy of less than twelve months, you can apply to receive your pension early. The Scheme Medical Adviser will still need to carry out a medical assessment to confirm that you are eligible to receive your pension early on severe ill health grounds. However, the assessment should be completed very quickly in such circumstances.

The Scheme Medical Adviser will review the application (order) form when it is received to make sure it is complete and that all the necessary paperwork has been sent. If anything is missing, they will contact your employer to ask for missing information to be provided if it is easily obtained. They will return applications that have substantial parts missing. The timescale for completing an assessment, will not start until all necessary and complete papers have been sent to them.

If the Scheme Medical Adviser decides that there is enough information to complete an assessment without them having to obtain further information, they will produce an outcome report and certificate within 10 working days of receipt of your application. For information see ‘The Scheme Medical Adviser’s assessment report’. If the Scheme Medical Adviser needs further evidence they will obtain this:

• Through a personal consultation with you or;
• Through obtaining a third party report from your doctor and/or specialist.

Sometimes they will do both. They will keep you and your employer informed where this is happening.

• The Scheme Medical Adviser will telephone you to arrange this, and send written confirmation of the appointment to you and to your employer. If you subsequently cancel a consultation, they will rearrange the appointment on one occasion only. If the second appointment is not attended or is cancelled, no further appointment will be offered. If you fail to attend a consultation or cancel with less than 48 hours notice, there will be a full charge made to your employer for the consultation. If a second consultation doesn’t take place due to you cancelling or not attending, then your case will be assessed without this additional information. It is unlikely to be in your best interests if the Scheme Medical Adviser is not able to obtain the medical evidence they believe they need to assess your case. Where they have requested a consultation they will complete their assessment and produce an outcome report and certificate within 30 working days of receipt of the case. The 30 day timescale will not include periods (for example if you have rearranged or not attended an appointment), where the service stops. See ‘The Scheme Medical Adviser’s assessment report’ for information.
• If you attended a medical consultation and the physician you saw is an authorised Pension Scheme Adviser, you will have been made aware of the proposed content of the outcome report.

• If you attended a medical consultation but the physician you saw is not an authorised Pension Scheme Adviser, or if no medical consultation took place either due to your non attendance or because the information they have received is sufficient to complete an assessment without having to see you, a Pension Scheme Adviser will provide a report based on information received. In such instances, it will not be possible to provide information about the proposed content of the outcome report before it is processed by the Scheme Medical Adviser.

Please note:

The Scheme Medical Adviser will only make home visits to conduct a consultation in very exceptional circumstances, and at their discretion. If you identify that travel may be difficult your employer should actively consider assisting you with your travel arrangements.  Your employer is advised to discourage requests for home visits and to tell you that they are rarely possible.

• If a medical report is needed from your doctor, or specialist, or both, (referred to as a third party report), the Scheme Medical Adviser will send the request for a report from your doctor and/or specialist (or both, if needed) within 5 working days of receipt of the case. They will send two chase letters if a report has not been received after 20 days and then 25 days and will continue to process your case when the report has been received, or after 30 working days, if the report has not been received.

• Where the Scheme Medical Adviser has requested a medical report they will complete their assessment and produce an outcome report and certificate within 45 working days of receipt of the case. See ‘The Scheme Medical Adviser’s assessment report’ for information.

Where the Scheme Medical Adviser has requested both a personal consultation with you and a medical report (from your doctor, or specialist, or both), they will complete their assessment and produce an outcome report and certificate within 65 working days of receipt of the case. See ‘The Scheme Medical Adviser’s assessment report’ for information.

• The Scheme Medical Adviser is responsible for obtaining appropriate medical information about your condition in the first instance (with your permission). However, they will not pay in advance for medical reports from your doctor or specialist. This is because there is no guarantee of the quality of the report, how long it will take the doctor to provide it, or even that it will be provided.
• If you decide to get a report from your doctor or specialist yourself to support your application for ill health retirement you can do so, but you may be asked to pay for the report. If you decide to pursue your doctor or specialist for a report and they have refused to provide it without advance payment and you do not want to, or are not able to pay for it, you should speak to your employer about payment options (your employer is invoiced for any charges made to the Scheme Medical Adviser by a doctor or specialist for a medical report anyway – as stated in the service contract). Your employer may be willing to pay for the report if the doctor or specialist is asking for advance payment, or they may agree to recompense you for paying for a report. You will need to discuss any options with your employer.

Please note:

Where a doctor or specialist refuses to release information without advance payment for the report and no alternative arrangements are made to pay for the report in advance, the ill health retirement assessment will proceed without the report, using any other medical evidence that has been gathered and is available.

Once the Scheme Medical Adviser has completed their assessment they will produce an outcome report and certificate for your employer. Your consent is needed for them to send the outcome report to your employer. The report will confirm whether or not you have a qualifying medical reason for ill health retirement.

Please note:

Your employer cannot offer ill health retirement without a report and certificate from the Scheme Medical Adviser confirming that you have a qualifying medical reason for ill health retirement.

You will automatically be sent a copy of the report at the same time as it is sent to your employer (if you have consented to this). However, you can ask to see a copy of it before it is sent to your employer. You will have 5 working days from the date the report is issued to you to:

• ask the Scheme Medical Adviser to correct any factual errors in the report;
• withdraw consent for the report to be sent to your employer

You will only be given one opportunity to ask for factual errors to be corrected and must contact the Scheme Medical Adviser within 5 working days of the date the report is sent to you, to ask for any such errors to be corrected. See ‘Correcting Factual Errors in the Scheme Medical Adviser’s report’.

If you have asked for the report to be amended, the Scheme Medical Adviser will write to you either providing a copy of the amended report or telling you that they will not make changes to it.

If you have requested that the report is amended, the Scheme Medical Adviser can no longer send any report to your employer without your renewed consent to do so. It is therefore essential that you contact them within 5 working days of the date on the corrected report (or the letter telling you that they will not make changes to the report), to inform them whether you wish them to release the report to your employer or not. If they do not hear from you within this timescale they will inform your employer that they do not have your consent to release the report and that they are therefore unable to provide any advice. Please read ‘Withdrawing consent for the Scheme Medical Adviser to send their report to your employer’ to understand the impact this will have on your ill health retirement assessment.

The purpose of the advance notification process is purely to give you an opportunity to correct any perceived factual errors. It is not an opportunity for you to request a review or re-consideration of your case by submitting some extra medical detail. There is no scope for you to challenge the Scheme Medical Adviser’s independent medical assessment of your case as expressed in the opinion and outcome in the report at this point in the assessment procedure.

Factual errors are mistakes in the report such as misspelt names or incorrect dates. They do not cover clinical opinion so, you cannot ask the Scheme Medical Adviser to review their decision on ill health retirement at this point, or introduce new evidence that was not available at the time the assessment was completed.

Please note:

See ‘What if I disagree with the Scheme Medical Adviser’s assessment?’ for information about what to do if you disagree with the ill health retirement assessment. Also see ‘What if I have a query or complaint about aspects of the ill health retirement process?’ for information about routes available for raising other types of queries or complaints.

It is unlikely to be in your best interests to withdraw consent for the Scheme Medical Adviser to send their report to your employer, because without a report and certificate: 

• it will be taken that you have stopped the ill health retirement process;

• 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 considered the appropriateness of ill health retirement;

• you will not be able to appeal against the Scheme Medical Adviser’s ill health retirement assessment.

• you will not be able to apply for retrospective ill health retirement.

You will receive a copy of the outcome report from the Scheme Medical Adviser after your ill health retirement assessment has been completed, unless you say that you do not wish to see a copy of it. If you attended a medical consultation and the physician you saw is an authorised Pension Scheme Adviser, you will have been made aware of the proposed content of the outcome report. You can also ask to see a copy of the report before it is sent to your employer.

Your employer must formally tell you whether or not your ill health retirement assessment has been successful and give you details of the Scheme Medical Adviser’s advice. Your employer must also tell you how you can appeal against the assessment, as well as what further action they intend to take in relation to your employment. See ‘What if I disagree with the Scheme Medical Adviser’s assessment?’ for information about what to do if you disagree with the ill health retirement assessment.

If the Scheme Medical Adviser does not support ill health retirement after your assessment has been completed, you or your employer can progress with any plans you or they may have, to end your employment. You have a right to appeal against the ill health retirement assessment, within specified time limits – see ‘What if I disagree with the Scheme Medical Adviser’s assessment?’ for more information about this. An appeal can continue if your service is terminated after your employer has told you the results of your ill health retirement assessment, as long as the appeal is made within the specified time limits.

Please note:

The final decision on ill health retirement rests with your employer, even if the Scheme Medical Adviser has confirmed that you satisfy the scheme criteria for ill health retirement, but it cannot be offered unless the Scheme Medical Adviser has confirmed that you satisfy the scheme criteria for ill health retirement.

If you disagree with the content of the report and your disagreement relates to medical opinion (rather than factual errors), or you have additional evidence you would like to be taken into account, the only way to challenge this is to follow the formal appeals procedure.

• The Medical Reviews and Appeals Guide provides details of the appeals procedure. Your employer should give you a copy of this guidance. 

• You cannot appeal against the scheme medical adviser’s assessment if you withdraw consent for the report and certificate confirming whether or not you have qualifying medical reason for ill health retirement to be issued to your employer (see ‘Withdrawing consent for the Scheme Medical Adviser to send their report to your employer’).

• The appeal period does not start until your employer has formally told you whether or not your ill health retirement assessment has been successful.

If you have left your employment and have a preserved pension in classic only, you may apply to receive your pension benefits early if your health breaks down after leaving. Your benefits will not be enhanced but they do attract pensions increase and are not subject to further review. 

The condition for early payment of a preserved pension in classic are that, after leaving your employment with a preserved pension in classic, you fall ill before your scheme pension age and had you remained in your employment as a member of classic you would have been retired on grounds of ill health.

Early payment of preserved pension on medical grounds is not available to classic plus, premium or nuvos members – except in cases of serious ill health in which life expectancy is twelve months or less (see ‘What if I discover I am terminally ill?’)

Please note:

Early payment of a preserved pension is not the same as considering ill health retirement retrospectively which is an exceptional measure considered only in very restricted circumstances (see ‘What happens if my employment is terminated before an ill health retirement assessment has been completed?’).

Applications for medical assessment should be made through your former Civil Service employing department (or through MyCSP if the department no longer exists), using the form EPPA1. The EPPA 1 form is similar in structure and content to the IHR form – see ‘as much current evidence as possible to support the application'. (Medical information is only considered current if it has been supplied within the last 3 months).

The current EPPA1 form to use can be found here.

Your original letter of application will be helpful and this is particularly so if it is accompanied by a letter from your doctor. 

Your previous employer will be asked to provide a job description of the job you were doing when you left the service. It may be difficult to identify an accurate job description for you if you left some time ago. In such circumstances a general description of the duties will suffice, including any specific physical or mental requirements of the job.

Any occupational health records kept by your employer will also be very valuable, particularly if you were employed within the Civil Service more recently. Your employer should send these with your application. If the available medical evidence sent with the application is inadequate the Scheme Medical Adviser will remedy by either examining you and/or by obtaining medical reports from your doctor, or specialist, or both.

Queries 

If you have any queries about the ill health retirement procedures or the topics covered in this guidance, or an existing application for ill health retirement, you should speak to your employer (or ex-employer if you have already left your employment and the CSPS), in the first instance. Your employer will contact MyCSP for advice if they are unable to answer your query, or need authorisation to take further action, such as apply for retrospective ill health retirement or an extension to an appeal deadline.

If you need to contact the Scheme Medical Adviser because you have a question about an existing application for ill health retirement or because you need to pass on information that is specific to your application.

Should you or your employer wish to complain about the service provided by the Scheme Medical Adviser you should follow the complaints procedure outlined here. Examples might include matters’ relating to the convenience of any appointment or the way the Scheme Medical Adviser carried out the medical consultation. This process does not cover the procedure for dealing with medical appeals about Scheme Medical Adviser recommendations – The complaints process is also separate from the Internal Dispute Resolution procedure – please see the Internal Dispute Resolution FAQs page.

Complaints

Where you raise a complaint, your employer must first decide whether it refers to the Scheme Medical Adviser and, if so, that they want them to investigate. Your employer may be able to respond to your complaint yourselves, explaining any problems or delays. If they do feel that it is appropriate to refer the complaint to the Scheme Medical Adviser they will ask you to complete form Med 9, or they may complete the form on your behalf. Whoever is making the complaint should complete section 1 of the form. Your employer or MyCSP should complete section 2 of the form.

• The current Med 9 form in use can be found here

• All complaints must be sent by your employer on form Med 9 to the Scheme Medical Adviser.

• The Scheme Medical adviser will tell your employer when they have received the Med 9 form within 2 working days and will normally provide a full reply within 10 working days, or 21 working days if the complaint requires further investigation by a clinician. They will tell your employer which timeline applies. The reply will be provided to your employer. Where the case concerns a complaint you have made, your employer must give you written details about the outcome.

How to escalate a complaint

If you are dissatisfied with the response from the Scheme Medical Adviser you should tell your employer. If your employer feels the matter has been resolved they must explain their reasons to you. If they agree with you that your complaint remains unresolved or they have made a complaint that remains unresolved, they will escalate the complaint to the Scheme Medical Adviser’s account manager. The Account Manager will acknowledge receipt of the complaint within 2 working days and aim to provide a full reply to your employer within 10 working days.

Escalation route for complaints that remain unresolved

If you, or your employer’s complaint remains unresolved after the above routes have been exhausted and 10 working days have passed since escalating the complaint to the Account Manager, your employer should escalate it to MyCSP with a note of previous action taken and any response received from the Scheme Medical Adviser. MyCSP will arrange for the complaint to be investigated by the appropriate authority in MyCSP who will aim to give a response to you or your employer’s unresolved complaint within 10 working days.

Health Management
Ash House
The Broyle
Ringmer
East Sussex
BN8 5NN

classic Scheme Terms

Prevented – means having a significant incapacity. It does not mean “unwilling”, “disinclined to” or “inconvenient to” undertake the duty. The employer will have obtained occupational health advice to identify any employment adjustments to possibly overcome the obstacles to working. The individual will usually have co-operated with this. The employer will only consider ill health retirement if they conclude that such adjustments are on balance unreasonable or unfeasible to implement. Collusion between employer and employee to manipulate the pension scheme is considered fraud.

Ill health – means a recognised medical condition which gives rise to the incapacity. Diagnosis must be supported by appropriate clinical findings. Discharging his/her duties – means providing regular and efficient service in the normal duties of their responsibility level. It does not mean “all work” in the Civil Service context.

Likely – means ‘on a balance of probabilities’. The permanence of the ill health does not have to be ‘beyond reasonable doubt’ but rather more likely than not. The medical adviser takes into account the effect of standard treatment when considering the incapacitating effects of a condition. In doing this they take into account the chances of a successful outcome.

Permanent – means until pension age. Not only does the ill health have to be permanent but it has to result in permanent incapacity. Many permanent medical conditions (for example asthma, diabetes, epilepsy) do not usually prevent individuals from working normally. 

premium and nuvos Terms (as above unless specified below)

Breakdown in health – means ill health caused by a recognised medical condition giving rise to the incapacity. Diagnosis must be supported by appropriate clinical findings.

Incapacity – means unable to work due to the breakdown in health. Prevents – means having a significant incapacity. It does not mean “unwilling”, “disinclined to” or “inconvenient” to undertake the duty. The employer will have obtained occupational health advice to identify any employment adjustments to possibly overcome obstacles to working. The individual will usually have co-operated with this. The employer will only consider ill health retirement if they conclude that such adjustments are on balance unreasonable or unfeasible to implement. Collusion between employer and employee to manipulate the pension scheme is considered fraud.

Discharging their duties – means providing regular and efficient service in the normal duties of their responsibility level. It does not mean “all work” in the Civil Service context.

Please note:

Individuals do not have to be incapable of attending work but rather incapable of providing acceptable levels of performance or attendance. What is ‘acceptable’ is governed by the requirement to make reasonable adjustments for those with health problems and, particularly if they are likely to fall within the scope of the Equality Act and equivalent legislation in Northern Ireland 1995.

Incapable of undertaking other gainful employment – the individual’s functional ability to carry out any reasonable paid employment should have been impaired by more than 90%. That is, they may be capable of undertaking some types of job, but this is severely restricted by their loss of function caused by the illness. Incapable of doing own job or a comparable job – means unable to turn up regularly to do a job at the same or equivalent grade level. They will however be capable of doing a range of other types of work. Pension age – means the earliest age at which a member can take their pension without it being reduced because of early payment.

The following notes explain the type of information the Scheme Medical Advisor will be looking for before assessment that you meet the definition of ill health retirement:

Medical Evidence

There needs to be reasonable objective medical evidence that you: 

• Have a recognised medical condition;
• That this condition renders you incapable of your normal duties and/or any other employment;
• That the condition renders you incapable of providing regular and effective service;
• That despite appropriate treatment that the incapacity for work for regular and effective service is likely to be permanent.

It is often difficult to conclude, that an illness will not resolve or improve, until all evidence-based treatments currently widely available for the specific illness, have been completed. The reason for this difficulty is a realistic expectation in most circumstances that remaining treatment options will improve symptoms and functional capabilities to enable a return to work. There may be circumstances where you have had certain treatments, but there are remaining treatments available to you. In this situation, the Scheme Medical Advisor considers:

• The likely effects of outstanding evidenced-based treatments on the incapacitating effects of the scheme member’s medical condition;
• The likely results of possible treatments;
• The prospects of the outstanding treatments taking place before normal pension age;
• Whether there will be sufficient functional improvement for a return to work before normal retirement age.

Cases are considered on an individual basis and recommendations are based on the balance of probabilities. However, there does need to be a reasonably secure evidence base and reports from doctors are almost always essential. In general, the expectation is that such reports would come from your medical consultant. The Scheme Medical Advisor is not looking for an opinion on ill health retirement from such specialists in their reports, but clear information on the treatment that has been administered, the response to that treatment and whether there are remaining treatment options. A clear opinion on the likely long term outlook for the medical condition and the probable impact of future treatment is often very valuable. In general, medical evidence should be comprehensive, current (within the last 3 months) and provide sufficient medical detail to indicate that the scheme definition is likely to be satisfied. This approach is applied to all types of cases. However, there are certain types of case where there may be a need for reports from more than one specialist. This is more likely to be a requirement in conditions where clinical signs may be softer (for example, psychiatric and some musculoskeletal cases) or in medically less than fully explained conditions, The Scheme Medical Advisor almost always needs a diagnosis to be able to pass a judgement on the likely future course of an illness. Cases with chronic symptoms for which there is no underlying cause are therefore most unlikely to meet the scheme criteria.

Non Medical Evidence

Consideration of adjustments and redeployment at exit from employment under the Equality Act legislation is just as important as at entry to employment. Clear evidence and statements of the employment adjustments made to facilitate effective working is essential. When such modifications to work have been successful in overcoming obstacles to effective work it is important to understand if the employer can maintain the modifications in the long term or is only able to support the modifications temporarily. When such modifications to work have not been successful it needs to be clearly explained why such initiatives have not had the desired effect. It is also necessary to understand whether there is any further potential to implement additional modifications to work.