Ill Health pension refusal

flamevolvo

hello, i need some advice, i work for the civil service and was transferred to the Alpha pension scheme in April last year. I have been suffering form unexplained blackouts for about eight years which have progressed for just when standing with a short warning to when sitting/standing with no warning. This culminated in a serious RTA last April and has lead to me being put in for ill health retirement which was refused on the grounds of them not knowing if it is permanent and because of my age (43) in their opinion 'is likely to get better'. I have been undergoing various tests over the eight years with many suggestions to the cause which are either ruled out latter or there is no evidence to support it. So i don't yet have a diagnosis. Most of the 'refusal' report was full of 'unlikely to' statements including unlikely to meet the schemes criteria for ill health. Surely as the schemes medical adviser how i did not meet should make a firm decision. Any medicals i had for ill health stated in their reports that ill health recommended, including the medical on behalf of the pension scheme. I am in the process of appealing the decision as the scheme rule allow for instances were you can be given a provisional pension if it is not known if a condition is permanent. any advice help would be appreciated.

Browntoa

they are correct as it stands as you have no diagnosis


its possible that next month someone finally found the cause and its could be remedied with a simple operation or course of drugs

PensionTech

I disagree with Browntoa's statement above.

Ill-health retirement cannot be withheld on the off chance that medical science will improve and an as-yet-unforeseen cure will materialise. This position has been argued with, and defeated by, the Pensions Ombudsman in the past. Whether or not there is a known diagnosis makes very little difference. (Chronic Fatigue Syndrome, for instance, is frequently successful in ill-health applications - despite widespread medical disagreement about the classification, prognosis or even existence of the disease. It is the symptoms, not the name, of the condition that matter.) It would similarly be inappropriate to withhold ill-health retirement from someone with, say, Huntington's disease on the speculative basis that a cure might be found in future.

The proper criteria for ill-health retirement are set by the scheme rules, but generally the correct issue to consider is whether, on the balance of probability and using all information currently available, the member is likely to remain incapacitated for the foreseeable future. From the description given, it's impossible for us to judge whether or not the medical examiners have reached their decision in a fair and correct manner. However, I don't think I'm going too far in pointing out that decisions about whether to grant ill-health retirement are frequently contested by members who feel that they have been unfairly withheld. Those contests are frequently won; the scheme, employer and/or medical panel is found to have taken into account irrelevant or spurious information and ignored relevant information, and are directed to reconsider their decision on an appropriate basis. It must be said that it's very rare for a regulator or Ombudsman to actually replace the trustees' decision with their own - particularly where medical conditions are concerned - so there is no guarantee that the trustees will reach the conclusion that the member wants them to reach even if they are made to reconsider it.

To answer your question - can you be given a provisional pension if it is not known whether a condition is permanent - I would suggest that it is possible, if current information suggests that it is a long-term condition and there is no current treatment that could be reasonably expected to improve it. I can't tell you that those are definitely the criteria that should be considered and your appeal will definitely succeed on that basis. This kind of thing can be quite subjective; although the use of independent medical examiners is supposed to remove bias, it seems that it often doesn't. Without being a doctor myself, I can't say that it would be reasonable to consider you incapacitated for the foreseeable future. But from the information you've given, including the fact that your own medical assessments have reached a different conclusion to the scheme's medical adviser, I think it is an appeal worth making.

PensionTech

I would add to this that there is more research you can do, if you have the appetite for it.

The Pension Ombudsman (where these disputes invariably end up after exhausting all appeals through the scheme) publishes all determinations. You may find it useful to read through some of the ill-health cases to get an idea of what schemes often get wrong, and use that to assess whether or not the scheme has made any errors in your case. I have filtered the following search on successful complaints by members against schemes for ill-health cases:
https://www.pensions-ombudsman.org.uk/our-decisions/?determination-type=complaint-dispute&topic=ill-health&outcome=upheld&s

Do bear in mind, though, that not all of these appeals are successful; you can re-filter the search to find the ones that fail as well. There will be a temptation to try to fit your situation to the successful appeals and ignore any resemblance to the failed appeals. Do try to stay objective and work out whether, on the basis of your research, an impartial adjudicator is likely to find in your favour.

Finally I must point out that progression to the Ombudsman is a last resort. It sounds like you are already going through the scheme's internal appeal process, which has to be fully exhausted before you can move it on. If you need any assistance with going through the initial appeals, I would suggest contacting The Pensions Advisory Service: http://www.pensionsadvisoryservice.org.uk/contacting-us

atush

I would think ou should be on sick leave while awaiting a proper diagnosis. and getting referrals to specialists etc. I cant see any ill health retiral being possible if no one knows what is wrong and if it is permanent?

In any case you have two identical threads, which will be confusing for you and others if people start posting to the other one (currnetly empty) so go delete it so all answers will be here?

Good luck with your appeal (and search for a diagnosis).

hyubh

Browntoa wrote: »

they are correct as it stands as you have no diagnosis

its possible that next month someone finally found the cause and its could be remedied with a simple operation or course of drugs

Along with PensionTech's analysis, I can't find evidence that 'provisional' awards of an ill health pension at least hinge on this in the scheme regulations:

Provisional award of ill-health pension

75.—
(1) This regulation applies if the scheme medical adviser is unable to form an opinion on the following matters—

(a) whether a member (P) has suffered a permanent breakdown in health involving incapacity for employment or total incapacity for employment;

(b) whether P’s breakdown in health involves—

(i) incapacity for employment; or
(ii) total incapacity for employment.

(2) The scheme medical adviser may recommend that—

(a) for a period specified in the recommendation (being a period of not more than 5 years), P is taken to have suffered a permanent breakdown in health involving whichever of the following is specified in the recommendation—

(i) incapacity for employment; or
(ii) total incapacity for employment; and

(b) P’s case should be reviewed by the scheme medical adviser at the end of the period specified in the recommendation.

http://www.legislation.gov.uk/uksi/2014/1964/part/6/chapter/4/made

Tiddlywinks

So, are you making it into work everyday?

Do you feel you fit into the lower or upper tear definition for ill health retirement?

What do your consultants say is a likely prognosis? What treatments are they exploring?

What conclusions did Occ Health reach when assessing your condition against your job role?

Have you been considered for a move of role?


The scheme booklet for Alpha says:

How do I qualify for ill-health retirement?

You have to satisfy the following two criteria:

• You must have enough qualifying service to be eligible for a pension.
This means that you have worked for an employer that offers membership of the Civil Service Pensions
(CSP) arrangements, and been a member for at least two years.

• Your health must, in the opinion of the Scheme Medical Adviser (SMA), permanently prevent you from being able to do your current job or any other similar role.

Permanent means until you reach your predicted State Pension age (SPA). The SMA will take into account any planned changes to SPA when making this decision.

---

Lower tier - To qualify for a lower tier pension the SMA must agree that you are permanently incapable of doing your own job, or another similar role.

Upper tier - To qualify for an upper tier pension the SMA must agree that you are permanently incapable of working in any kind of employment.

Muscle750

Youve been suffering blackouts for eight years and yet you were still able to hold a driving licence this beggars belief. I lost my licence for 10 years due to me having epilipsy however im now back driving and have been for some years as im now ok and have been for 20 years Your health issues could be caused by all sorts of things one thing that triggered me going southbound was fried food and possibly Beef gravy stopped eating that and i was fixed why even the consultant was puzzled