Ill Health Certificates & Guides

Ill health retirement is available to all employees aged between 16 and 75 who have two or more years membership of the scheme. Three tiers of benefits are available for active members depending on the likelihood of the member being able to undertake gainful employment in the future. You may want to signpost the employee to the Ill Health Retirement Guide – Active Members.

Ill health retirement is an employer driven process and applies to both current employees and employees who have deferred benefits in the scheme. Tiers do not apply to employees with deferred benefits. You may want to signpost the employee to the Ill Health Retirement Guide – Deferred Members.

There is no upfront pension strain cost for ill health retirements as the cost is built into the employer contribution rate set at each triennial valuation.

Responsibility for deciding the grounds on which the employment of a Local Government Pension Scheme (LGPS) member will be terminated rests solely with the employer and is a separate issue to the award of ill health benefits. An employee’s employment can be terminated before the ill health process is completed with a certificate subsequently obtained to help determine whether the member satisfies the criteria for an ill health retirement pension.

An employer cannot make an ill health retirement determination unless they have obtained a certificate from an Independent Registered Medical Practitioner.

Employer Ill Health Guide for Active Members

(The terms shown in bold are explained in the glossary at the end)

 When to start the process

Under the LGPS regulations the employer has to terminate the member’s employment on the grounds of ill-health or infirmity of mind or body before the member’s Normal Pension Age (NPA).  Before deciding whether the member meets the conditions for an ill-health retirement pension and, if so, which tier of benefit to award the employer must obtain a certificate from an Independent Registered Medical Practitioner (IRMP) who has been approved by the administering authority.

The management of ill health in the work force and, in particular during the period leading up to the termination of employment, is outside the scope of the LGPS regulations.

Responsibility for deciding the grounds on which the employment of an LGPS member will be terminated rests solely with the employer and is a separate issue to the award of ill health benefits. A member’s employment can be terminated before the ill health process is completed with a certificate subsequently obtained to help determine whether or not the member satisfies the criteria for an ill health retirement pension.

It is expected however, that an employee suffering from ill health will have been through the ‘usual’ internal processes such as occupational health, attendance management etc. and that an assessment for ill health retirement would form part of that process. An employer cannot make an ill health retirement determination unless they have obtained a certificate from the IRMP.

Assessment

A member being considered for ill health retirement must be referred to an IRMP that has been appointed by their employer. The IRMP providing the certificate must not have previously advised or given an opinion on the case.

The IRMP should be provided with as much information with regard to the member’s job role and any supporting medical information such as GP or specialised reports as possible. It will be necessary therefore to obtain consent from your member of staff before releasing any information to the IRMP.

You should try to organise a referral to the IRMP as soon as possible to prevent a delay to the assessment. Following the assessment, the IRMP will issue an ill health certificate confirming their opinion on whether or not the member’s ill health or infirmity of mind or body renders them permanently incapable of discharging efficiently the duties of the employment they were engaged in i.e. would the member be able to continue doing their job. The IRMP will also consider whether the member’s ill health or infirmity of mind or body renders them not immediately capable of undertaking any gainful employment i.e. would the member at the time of the medical assessment be able to do a different job which satisfies the definition of gainful employment.

If the IRMP is satisfied that the member has met the criteria for an ill health retirement pension they will also recommend which tier of benefits should be awarded.

Decision

Following an opinion from the IRMP it is the employer who makes the final decision, based on the balance of probabilities, whether to award ill health retirement and to determine which tier of benefits to award. In making this decision you should:

  • Give strong regard to the IRMP’s medical opinion regarding the likelihood of the individual being capable of undertaking any gainful employment. It is important that you understand the reasoning of the IRMP and it is therefore useful if a narrative report is provided with the certificate.
  • Make sure you consider the person’s ability to undertake gainful employment taking into account non- medical factors that will aid or prevent them from doing so.
  • Document the decision making process so that it is clear why a decision has been made. This is particularly pertinent if the individual appeals.

If the member appeals, the opinions given by the IRMP will be given significant weight and any decision to not award ill health retirement or to award a different tier to that advised by the IRMP, must be backed up by clear justification for that decision.

If a decision is made to award ill health retirement, then a further decision needs to be made on the level of benefits to be paid. There are 3 tiers of ill health retirement depending on the member’s ability to undertake gainful employment in the future.

Tier 1

Awarded if the member is unlikely to be capable of gainful employment before their NPA. Ill health benefits are based on the pension the member has built up in their pension account at the date of ill health retirement, plus the pension they would have built up if they had been in the main section of the scheme until NPA.

Tier 2

Awarded if the member is unlikely to be capable of gainful employment within 3 years of leaving, but they are likely to be capable before NPA. Ill health benefits are based on the pension the member has already built up in their pension account at the date of ill health retirement, plus 25% of the pension they would have built up had they been in the main section of the scheme until NPA.

Tier 3

Awarded if the member is likely to be capable of gainful employment within 3 years of leaving or before NPA if earlier. Ill health benefits are based on the pension the member has already built up in their pension account at the date of ill health retirement. Payment of these benefits will be stopped after 3 years or earlier if the member is in gainful employment or becomes capable of such employment, provided they have not reached NPA by then.

Part time employment

Where a member has been working reduced hours and therefore had reduced pay the IRMP can certify that the member’s pay, for the period being used to calculate the assumed pensionable pay (APP) figure, was lower as a result of the member’s ill health. The employer can calculate the APP as if the member’s contractual hours had not been reduced.

If the member has always been part time the scheme employer can calculate the APP as if the member’s contractual hours had not been further reduced.

Information to be provided to the North Yorkshire Pension Fund (NYPF)

The NYPF will not provide estimates of pension benefits for ill health retirement. Quotations of the benefits payable can only be provided once the ill health retirement has been agreed. The NYPF will need the following:

Where the member’s leave date is in the future an ADNOT Form should be provided, along with the certificate and manager’s authorisation, as soon as possible in order for benefit options to be provided. This will reduce the delay at actual leaving.

Where tier 1 benefits are awarded it is recommended that employment is ended immediately and notice periods waived to prevent any delay which could result in the member dying in service instead.

What the NYPF will do

When the NYPF has received a completed ADNOT/Leaver Form, ill health certificate and authorisation that confirms the tier of benefits payable they will calculate the benefits payable to the member.

A retirement quotation and forms will be sent to the member within 5/10 working days however serious cases will be dealt with as a priority.  When the completed forms are received back from the member and the Leaver Form has also been received the benefits will be processed.

If a tax free lump sum is payable payment will be made on the first available Friday following receipt of all the relevant paperwork. Pension payments are made by BACs on the last working day of each month. Due to the normal payroll cycle the first pension payment may be paid up to 2 months after the member’s retirement date.

Ill health certificate received without supporting documentation

If the ill health certificate is received without an Leaver Form/member being entered as a leaver on i-connect and/or the employer’s authorisation to pay ill health retirement benefits, the NYPF will not be able to process the pension benefits or provide any pension quotations to the member. The NYPF must have all the required forms and authorisation in order to pay pension benefits.

If the ill health certificate and authorisation is received after the Leaver Form/i-connect leaver information and the retirement has already been processed the NYPF will recalculate the benefits in line with the tier of ill health awarded. There may be an administration charge payable for the recalculation.

The member will have already received payment of the normal benefits so it will be necessary to arrange payment of any pension arrears and additional tax free lump sum. Payment of normal benefits can be an issue however if the member had a relatively low level of benefits and this has been converted to a one off lump sum (known as trivial commutation). In this scenario the member may have received benefits they are not entitled to as the ill health uplift would take the level of benefits over the allowable amount for trivial commutation. In this case the member would be required to pay back the lump sum.

To prevent this, you should tell the NYPF that the member has been dismissed but that a possible ill health retirement case is ongoing, there is a tick box on the Leaver Form to indicate an ill health retirement application is in progress at the point of dismissal. The member record will be noted accordingly and the benefits will not be processed until the outcome of the ill health process is known. It is important that the NYPF is notified where the ill health application has been declined so payment of ordinary benefits can be made if applicable.

Glossary

Normal pension age: Age 65 or State Pension Age if later. This can be checked at: www.gov.uk/check-state-pension

Gainful employmentThis means paid employment with any organisation for at least 30 hours a week for a period of least 12 months.

Two years membership: to receive ill health retirement the member must have been in the scheme for 2 years or if they have less than 2 years they must have transferred in other pension benefits. This can be checked for you by the pensions section.

Independent Registered Medical Practitioner (IRMP): This is the practitioner who you approve to carry out medical assessments for pension purposes and to provide the necessary certificates. The practitioner must be suitably qualified in Occupational Health, be registered with the General Medical Council and have an understanding of the ill health regulations in the LGPS.

Assumed pensionable pay (APP): APP is the notional pay figure used to represent the normal pay the member would have had if they weren’t on reduced or nil pay. APP is calculated by adding together the monthly pay for the 3 complete months before the relevant event, excluding any pensionable lump sum payments and then grossing this figure up to an annual figure i.e. divide by 3 and multiply by 12.

Employer Ill Health Guide for Deferred Members

 Start of the process

A former employee who has pension benefits in the scheme and who wishes to apply for ill health benefits should contact their former employer to request an ill health assessment. The former employee will be assessed against their previous job role, the criteria for ill health retirement depends on when the member left the scheme.

Assessment

A member being considered for ill health retirement must be referred to an Independent Registered Medical Practitioner (IRMP) that has been appointed by their employer. The IRMP providing the certificate must not have previously advised or given an opinion on the case.

The IRMP should be provided with as much information with regard to the member’s former job role and any supporting medical information such as GP or specialised reports as possible. It will be necessary therefore to obtain consent from your former member of staff before releasing any information to the IRMP.

You should try to organise a referral to the IRMP as soon as possible to prevent a delay to the assessment. Following assessment, the IRMP will provide an ill health certificate confirming their opinion on whether or not the member meets the ill health criteria as follows:

Date of leaving Ill health criteria
Left on or before 31 March 2008 Assessed as permanently incapable of carrying out the job the member was working in when they left

Left between 1 April 2008

and

31 March 2014

Assessed as permanently incapable of carrying out the job the member was working in when they left

and

unlikely to be capable of carrying out gainful employment before age 65 or for at least three years, whichever is sooner

Left on or after 1 April 2014

Assessed as permanently incapable of carrying out the job the member was working in when they left

and

unlikely to be capable of carrying out gainful employment before NPA or for at least three years, whichever is sooner

Decision

Following an opinion from the IRMP it is the employer who has the final decision, based on the balance of probabilities, on whether to award ill retirement from deferred.

If ill health is granted the date the benefits are payable from depends on when the member left the scheme:

Date of leaving Date of payment
Left before 1 April 1998 Payable from the date the IRMP certifies that the member first met the criteria for payment of deferred pension benefits on ill health grounds
Left between 1 April 1998 and 31 March 2008 Payable from the date the member applied to employer to release benefits on ill health grounds
Left between 1 April 2008 and 31 March 2014 Payable from the date the IRMP certifies that the member first met the criteria for payment of deferred pension benefits on ill health grounds
Left on or after 1 April 2014 Payable from the date the employer determines that the member meets the criteria for early release of deferred pension benefits on ill health grounds

The benefit payable is the value of the deferred benefits including any increases applied since retirement. There is no enhancement to the benefits paid on ill health from deferred.

Information to be provided to the NYPF

The NYPF will not provide estimates for ill health retirement, figures can only be provided once the ill health retirement has been agreed. The NYPF will need the following to process the benefits:

  • Ill health certificate and manager’s authorisation.
  • Confirmation of the date the benefits are payable from.

What the NYPF will do

When the NYPF has received an ill health certificate and authorisation that confirms the date the benefits are payable from they will calculate the benefits payable to the member. A retirement quotation and forms will be sent to the member within 5/10 working days however serious cases will be dealt with as a priority.

When the completed forms are received back from the member the benefits will be processed. If a tax free lump sum is payable payment will be made on the first available Friday following receipt of all the relevant paperwork. Pension payments are made by BACs on the last working day of each month. Due to the normal payroll cycle the first pension payment may be paid up to 2 months after the member’s retirement date.

Glossary

Normal Pension Age: Age 65 or State Pension Age if later.

Gainful employment: This means paid employment with any organisation for at least 30 hours a week for a period of least 12 months.

Two years membership: to receive ill health retirement the member must have been in the scheme for 2 years or if they have less than 2 years they must have transferred in other pension benefits. This can be checked for you by the pensions section.

Independent Registered Medical Practitioner (IRMP): This is the practitioner who you approve to carry out medical assessments for pension purposes and to provide the necessary certificates. The practitioner must be suitably qualified in Occupational Health, be registered with the General Medical Council and have an understanding of the ill health regulations in the LGPS.

Assumed Pensionable Pay (APP): APP is the notional pay figure used to represent the normal pay the member would have had if they weren’t on reduced or nil pay. APP is calculated by adding together the monthly pay for the 3 complete months before the relevant event, excluding any pensionable lump sum payments and then grossing this figure up to an annual figure i.e. divide by 3 and multiply by 12.

Ill Health Certificates

It is important that you select the correct ill health certificate, if the wrong certificate is completed it will delay payment of the employee’s ill health pension benefits.  The Interactive and PDF versions of the certificates can be accessed below.

Ill Health Review Certificates

A Tier 3 provides a reviewable pension for an employee whose employment is terminated because they are permanently incapable of their current job but are likely to be capable of undertaking gainful employment within three years or before their normal pension age, if earlier.

The employer needs to check the employment status of the member when payments have continued for 18 months. These payments will stop if gainful employment has been obtained. If the member is not in gainful employment at the review, the employer has to check the latest medical position. Please see the employer Tier 3 ill health review guide for further information.

The following certificates should only be used where a Tier 3 ill health pension is being reviewed.