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?