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Good Quality Evidence. Scottish Public Pensions Agency Presentations 2011. Presentation Outline. The Relevant Regulations What evidence makes a good application Assessing for total incapacity Reasons for refusal. Two Tier Ill-Health Retirement Benefits from 01-04-2007. - PowerPoint PPT Presentation
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Good Quality Evidence
Scottish Public Pensions Agency Presentations 2011
Presentation Outline
▶ The Relevant Regulations▶ What evidence makes a good application▶ Assessing for total incapacity▶ Reasons for refusal
Two Tier Ill-Health Retirement Benefitsfrom 01-04-2007
Partial Incapacity B enefitP IB
Low er T ier
Total Incapacity B enefitT IB
U pper T ier
Tw o Benefits
STSS administrative changes effective from 01-10-2008
▶ No additional FME gathering▶ No face to face assessments, therefore▶ Fast turn around 5 days▶ Remove review facility ▶ Switch to 2 IDR procedures▶ Revised forms to allow for evidence to
be submitted.
Partial Incapacity definition for PIBThe Teachers’ Superannuation (Scotland) 2005 Amendment Regs 2007 - E6
▶ A teacher who has qualified for retirement benefits shall be entitled to payment of them if he falls within any of paragraphs 2 and 4 to 7
▶ Para 5- The teacher- (c) is incapacitated
Partial Incapacity definition for PIBSchedule 2
▶ In the case of a teacher, while he is unfit by reason of illness or injury and despite appropriate medical treatment to serve as such and is likely permanently to be so
▶ Permanence meaning to NPA▶ This is specific to the job the applicant holds (defined in
the core requirements ((hours and content)) of the contract of employment )
Total Incapacity definition for TIB Reg E10A The Teachers’ Superannuation (Scotland) (Regs
(as amended)
▶ In the case of a teacher, satisfies the condition 2 (a) ‘that (in addition to being incapacitated) the persons’ ability to carry out any work is impaired by more than 90% and is likely permanently to be so..’
▶ Permanence meaning to NPA▶ Unable to do any work in the general field of
employment▶ But may achieve therapeutic/voluntary work on
submission of a medical certificate.
Where we hope to find the evidence-STSS Referral Documents
In Service STSS (INC) parts 1- 2 need to be
completed, together with MED 1
Out of Service STSS (INC) part 1- applicant only
section completed, together with MED 1
What does the medical adviser have to consider?
▶ The Medical Adviser does not know the teacher, their medical history,
nor the school at which they teach.
▶ The medical adviser is required to consider the medical evidence that
is presented, and only that.
– What you submit!
Why might this give rise to a problem?
▶ Disease outcomes are not always clear cut.
▶ People survive diseases they previously died from.
▶ People get less disability from diseases they previously were disabled
by.
▶ People are living longer and healthier lives, even ones with a disease
label.
Source: National Statistics
Disability Free Life expectancy (England)
Males Females
2000-2002 2004-2006 2000-2002 2004-2006
Years 60.7 62.8 63.0 64.1
Proportion of life free from disability
79.9% 81.3% 78.2% 78.7%
12
This means
▶ Teachers may not be as sick as they seem▶ They may be capable of staying in their jobs with some assistance from
their employers▶ They may not get an Ill Health pension unless they employer has
undertaken consideration of adjustments and provides evidence for this▶ The employers will be struggling to get a case through unless they have
used an Occupational Health service to advise them on these matters.
The meaning of words.
▶ Permanent = to Normal Pension Age
▶ Incapacity = an inability to undertake a task or tasks
▶ There are No Fitness to teach Regs in Scotland, so there are no standardised core duties
▶ Illness or injury = a diagnosed medical condition { covered in the International Classification of Diseases}. Where there are multiple possibilities we need to be far enough along the diagnostic pathway to be able to estimate prognosis.
Reasonable treatment
▶ Reasonable treatment = the treatment that a reasonable person should undertake for their illness. Heroic measures not required. But the scheme is entitled to consider that a member would benefit from any reasonable treatment that is available and for which there is evidence of good effect.
▶ For psychiatric illness -
» have they seen a psychologist / psychiatrist?
» Have they had adequate medication?
▶ For Musculoskeletal Illness -
» Have they been worked up?
» Attempted or been rejected for surgery?
» Attended a pain clinic?
▶ For Cancers -
» Have they seen an Oncologist and
» Completed Chemotherapy / Radiotherapy?
STSS 2009-2010
0102030405060
Cancers MentalHealth
Musculoskeletal
Decision pattern with Cancers, Mental Health and Musculoskeletal
All Cases
TIB
PIB
Rejected
Reasons for rejection
▶ Insufficient evidence of an incapacitating condition
▶ Incomplete investigations
▶ Incomplete treatment.
When you refer a case to Occupational Health ask the following?
▶ This patient’s case is being considered for Ill health early retirement, can you please address the following.
• What condition(s) give rise to permanent incapacity in this case?
• Is there evidence that the teacher has completed reasonable treatment?
• Is there scope for rehabilitating the teacher back to their previous role?
• What roles could the teacher undertake between now and Normal Pension
Age outside of teaching?