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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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24.2 Complaints  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 Issue Date: 01/02/12 dealing with medical appeals about Scheme Medical Adviser recommendations – please see paragraph 20 for more information about medical appeals. The complaints process is also separate from the Internal Dispute Resolution procedure - please see the leaflet ‘If you have a complaint about your pension’, which is on the Civil Service pensions website: www.civilservice.gov.uk/pensions/helplines/internal-disputeresolution  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 on the Civil Service Website:

www.civilservice.gov.uk/pensions under ‘Guidance for employers’ – ‘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.

24.3 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.

24.4 Escalation route for complaints that remain unresolved If your, 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 Issue Date: 01/02/12 response to your or your employer’s unresolved complaint within 10 working days.

25 Scheme Medical Adviser Contact Details Capita Health & Wellbeing Wheatfield Way Hinckley Fields Estate Hinckley, LE10 1YG Tel: 0845 601 1994 Email: ReferralsIHR@capita.co.uk

–  –  –

Meaning of particular terms by scheme 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.

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.

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 Permanent - means until pension age. Not only does the breakdown in health have to be permanent but it also has to result in permanent incapacity. Many permanent medical conditions (e.g. asthma, diabetes, epilepsy, etc) do not normally prevent individuals from working normally.

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.

Issue Date: 01/02/12 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.

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.

–  –  –

Type of information the Scheme Medical Adviser will be seeking 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 Issue Date: 01/02/12 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.

–  –  –

Annual Allowance Fact Sheet for Civil Service pension scheme members leaving on ill-health retirement Do I need to read this information?

Yes, if you are leaving on ill-health retirement then you should read all the information in this fact sheet, as there is a possibility that you could incur an HM Revenue & Customs (HMRC) Annual Allowance tax charge. It is also possible that your medical condition may give you exemption from the potential tax charge. This fact sheet explains the Annual Allowance and the process you need to go through in order to be assessed against the exemption criteria.

What is the Annual Allowance?

The Annual Allowance sets the amount of pension saving that is allowed tax free in any one year. The tax regime has gone through some major changes for the tax year 2011-12, and this includes reducing the Annual Allowance to £50,000, and changing the method used to work out the Annual Allowance.

How is the Annual Allowance worked out for defined benefit schemes such as classic, classic plus, premium and nuvos?

Full details are available on the HMRC website, but in basic terms it is the increase in the value of your pension from one year to the next multiplied by 16, plus the increase in value of your automatic pension commencement lump sum (classic/classic plus only), with a measure for inflation taken into account.

How might this affect me if I am leaving on ill-health retirement?

Under some circumstances leaving on Ill-health retirement gives an enhancement to your pension benefits and this may result in a large increase in the value of your pension from one year to the next. For some individuals the enhancement will mean that the amount their pension benefits increase from one year to the next will go over the Annual Allowance limit. Please see the enclosed illustrative annual allowance estimate. Information on how to calculate your personal tax liability can be found at www.hmrc.gov.uk.

Are there any exemptions from the Annual Allowance tax charge for people leaving on ill-health grounds?

Yes, there are exemptions for people leaving because of what HMRC term ‘severe illhealth’; however the criteria are different to those that we use in the Civil Service pension scheme to determine if you qualify for Ill-health retirement.

What are the HMRC criteria for ‘severe ill-health’?



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