«Ill Health Retirement – Guide for Members Contents Page 1 Introduction 1.1 General 2 Before making an application for an ill health retirement ...»
Ill Health Retirement – Guide for
2 Before making an application for an ill health retirement assessment.............3
2.1 Points to consider
3 Ill Health Retirement Qualifying Conditions
4 Ill Health Retirement Criteria
5 Who does the ill health retirement assessments?
6 How do I apply for ill health retirement?
7 The IHR form
7.1 IHR Form - overview
7.2 IHR - P1 in more detail
7.3 IHR – P2 in more detail
8 What if I discover I am terminally ill?
9 Will my employment continue if I have been referred for an ill health retirement assessment?
10 Can an ill health retirement referral be refused or stopped for any reason?
11 What happens if my employment is terminated before the ill health retirement assessment has been completed?
12 Can I apply for ill health retirement if I have already left my employment and the Civil Service Pension Scheme (CSPS)?
13 What happens after an application is sent to the Scheme Medical Adviser?
13.1 Scheme Medical Adviser Actions
13.2 If a personal consultation is needed
13.3 If a medical report from your doctor, or specialist, or both is needed........... 12 13.4 If a personal consultation and a medical report is needed
13.5 Requests for advance payment for a medical report from your doctor or specialist
14 The Scheme Medical Adviser’s assessment report
Issue Date: 01/02/12 15 Receiving an advance copy of the Scheme Medical Adviser’s outcome report
16 Correcting Factual Errors in the Scheme Medical Adviser’s report................ 14 17 Withdrawing consent for the Scheme Medical Adviser to send their report to your employer
18 How will I find out the results of my ill health retirement assessment?.......... 15 19 What if the Scheme Medical Adviser does not support ill health retirement?
20 What if I disagree with the Scheme Medical Adviser’s assessment?.............. 16 21 Early Payment of Preserved Pension (EPPA)
22 How to apply for an EPPA medical assessment
23 What documents will the Scheme Medical Adviser require for EPPA assessments?
24 What if I have a query or complaint about aspects of the ill health retirement process?
24.3 How to escalate a complaint
24.4 Escalation route for complaints that remain unresolved
25 Scheme Medical Adviser Contact Details
Meaning of particular terms by scheme
Annual Allowance Fact Sheet for Civil Service pension scheme members leaving on ill-health retirement
Issue Date: 01/02/12 1 Introduction
1.1 General This guide tells you about the eligibility conditions, criteria and procedure for applying for ill health retirement benefits from your Civil Service Pension scheme if you have to leave your job early because you are ill.
It does not tell you how ill health retirement benefits are calculated or what benefits may be paid. If you wish to find out more about what benefits may be paid you should refer to the appropriate scheme booklet.
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.
2 Before making an application for an ill health retirement assessment
2.1 Points to consider 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.
3 Ill Health Retirement Qualifying Conditions 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.
4 Ill Health Retirement Criteria 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.
Issue Date: 01/02/12 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).
Please note: An explanation of the meaning of particular terms mentioned above is given in Annex A.
5 Who does the ill health retirement assessments?
All ill health retirement assessments must be done by the Scheme Medical Adviser. The Scheme Medical Adviser is appointed under contract to the Scheme Management Executive at the Cabinet Office as the sole provider of advice on access to medical-related Civil Service Pension Scheme benefits.
The current provider is Capita Health & Wellbeing.
6 How do I apply for ill health retirement?
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 (see paragraph 3).
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 section 6.3.2 of the Civil Service Management Code (CSMC), 2009 – available on the website, www.civilservice.gov.uk/about/resources/civil-servicemanagement-code.
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 Issue Date: 01/02/12 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 in paragraph 7. A copy of the current order form can be
found on the Civil Service pension website:
Please note: The Scheme Medical Adviser may also need to consider whether or not a member satisfies the criteria for HMRC severe ill health, in relation to the Annual Allowance. This separate assessment is only carried out if the member may be affected by the new annual allowance limits. More information about the effect of these changes on the ill health retirement process is given in Annex D of this guide.
7 The IHR form
7.1 IHR Form - overview The IHR form is in two parts. P1 is for you to complete and sign (as relevant) and P2 is for your employer to fill in.
7.2 IHR - P1 in more detail 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.
Issue Date: 01/02/12 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
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 paragraph 16 for more information about ‘Correcting Factual Errors in the Scheme Medical Adviser’s report’.
Important notes - 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 (as reiterated on the application form and in paragraph 17
below). 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 paragraph 20 below for more information about what to do if you disagree with what the Scheme Medical Adviser has written in their report. Also see paragraph 24 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 Issue Date: 01/02/12 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.