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«Ill Health Retirement – Guide for Members Contents Page 1 Introduction 1.1 General 2 Before making an application for an ill health retirement ...»

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13.4 If a personal consultation and a medical report is needed  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 paragraph 14 for information about ‘The Scheme Medical Adviser’s assessment report’.

13.5 Requests for advance payment for a medical report from 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). However, they will not pay in advance for medical reports from you 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 Issue Date: 01/02/12  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.

14 The Scheme Medical Adviser’s assessment report 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 (see the notes about the IHR – P1, Medical Consent Form 2 in paragraph 7.2 above). 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 paragraph 16 on ‘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.

Issue Date: 01/02/12 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 paragraph 17 on ‘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.

15 Receiving an advance copy of the Scheme Medical Adviser’s outcome report 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.

16 Correcting Factual Errors in the Scheme Medical Adviser’s report 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 paragraph 20 on ‘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 paragraph 24 on ‘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.

17 Withdrawing consent for the Scheme Medical Adviser to send their report to your employer 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;

Issue Date: 01/02/12  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.

18 How will I find out the results of my ill health retirement assessment?

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 – see the notes about the IHR – P1, Medical Consent Form 2 in paragraph 7.2 above.

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 paragraph 20 on ‘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.

19 What if the Scheme Medical Adviser does not support ill health retirement?

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 paragraph 20 on ‘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.

Issue Date: 01/02/12 20 What if I disagree with the Scheme Medical Adviser’s assessment?

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. The

guidance can also be found on the Civil Service Website:

www.civilservice.gov.uk/pensions/guidance-for-employers/scheme-medicaladvisor under ‘Guidance for employers’ – ‘Scheme Medical Adviser’.

 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 paragraph 17 on ‘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.

21 Early Payment of Preserved Pension (EPPA) 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 paragraph 8 on ‘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 paragraph 11 on ‘What happens if my employment is terminated before an ill health retirement assessment has been completed?’).

22 How to apply for an EPPA medical assessment 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 paragraph 7 on ‘The IHR form’. You must supply Issue Date: 01/02/12 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 on the Civil Service Website:

www.civilservice.gov.uk/pensions/guidance-for-employers/forms under ‘Guidance for employers’ – ‘Forms.

23 What documents will the Scheme Medical Adviser require for EPPA assessments?

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.

24 What if I have a query or complaint about aspects of the ill health retirement process?

24.1 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 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, contact details are given in paragraph 25.



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