Ill health retirement declined by Medigold. Any advice on appeal ?

[kingrollo]

Did Medigold fail to even put you in tier 1. ?

Yep.

This is why I don't think a full appeal is appropriate. They have said on the balance of probability and with continued treatment it is reasonable to assume I would be fit enough to work before normal pensionable age.

But they refuse to enter dialogue as to what the treatments are. I have been discharged by cardiology, had failed nerve ablation for my spine pain (next step spinal fusion) and have had the allotted counseling sessions from the NHS for anxiety and depression...and have even funded sessions myself.

Imo I have exhausted all reasonable treatment options.

 

[midlife]

Yep.

This is why I don't think a full appeal is appropriate. They have said on the balance of probability and with continued treatment it is reasonable to assume I would be fit enough to work before normal pensionable age.

But they refuse to enter dialogue as to what the treatments are. I have been discharged by cardiology, had failed nerve ablation for my spine pain (next step spinal fusion) and have had the allotted counseling sessions from the NHS for anxiety and depression...and have even funded sessions myself.

Imo I have exhausted all reasonable treatment options.

I’m not sure they have to enter into any dialogue. You can access their report via a SAR as mentioned

The decision isn’t about treatments it’s about which tier you fit into. A binary decision……. Tier 1 or2

Tier 2 essentially means you are so ill you will never be able to work again, not even answer the phone for the NHS. Tier 2 essentially writes you off as future employment goes so you can never pay pension contributions and so there is a pension uplift.

The idea behind tier 1 which you are in IIRC is that you are too ill to do your current or similar job so can take your reduced pension before the usual age which for 2015 pension is 65. If you are pensioned off Tier 1 at age 40 it means that you get 25 years of extra pension for your contributions.

Tier 1 leaves you free to apply for another job in the NHS which is less demanding, then start paying into your pension again if you wanted

After a period of time if you become so ill you can never work again you can apply for a tier 2. I think that’s after 3 years but may be wrong.

 

[kingrollo]

I’m not sure they have to enter into any dialogue. You can access their report via a SAR as mentioned

The decision isn’t about treatments it’s about which tier you fit into. A binary decision……. Tier 1 or2

Tier 2 essentially means you are so ill you will never be able to work again, not even answer the phone for the NHS. Tier 2 essentially writes you off as future employment goes so you can never pay pension contributions and so there is a pension uplift.

The idea behind tier 1 which you are in IIRC is that you are too ill to do your current or similar job so can take your reduced pension before the usual age which for 2015 pension is 65. If you are pensioned off Tier 1 at age 40 it means that you get 25 years of extra pension for your contributions.

Tier 1 leaves you free to apply for another job in the NHS which is less demanding, then start paying into your pension again if you wanted

After a period of time if you become so ill you can never work again you can apply for a tier 2. I think that’s after 3 years but may be wrong.

I have a copy of the report explaining their decision.

As I have said the reasoning in the report is that I will get better with on going treatment. Imo the decision makes the assumption that treatment options are available - which imo they aren't .

 

[fossyant]

Are you still working, off sick or retired/not working. If you are still working you could go off sick, then back working if feeling OK, then back off again - play the system. I would appeal.

 

[Rusty Nails]

I know nothing about the NHS Pension Pension Scheme, but I did work in the pensions field for a while and I know there are always strict protocols that must be adhered to in any disputes if you want any hope of success.

I did a quick search and found this info via AI on the NHS scheme appeals procedure:

"You can appeal to The Pensions Ombudsman (TPO) if your application for NHS ill-health retirement has been rejected. However, you cannot usually go straight to the Ombudsman. You must first exhaust the formal internal appeal process with Medigold and the NHS Business Services Authority (NHSBSA).

The Mandatory Appeal Process. Before the Ombudsman will accept your case, you must follow the Internal Dispute Resolution Procedure (IDRP):

- Stage 1 Appeal (IDRP Stage 1): You must complete a Stage 1 application form and submit it to Medigold along with any new, relevant medical evidence. A different medical officer will review your case.
- Stage 2 Appeal (IDRP Stage 2): If Stage 1 is unsuccessful, you can escalate the case to the NHS Business Services Authority (NHSBSA). A completely separate scheme manager and independent medical adviser will assess it.
- The Pensions Ombudsman: If your Stage 2 appeal is also rejected and you still believe the decision was made incorrectly, you can then formally submit your complaint to The Pensions Ombudsman.

How the Ombudsman Reviews Your Case. It is vital to understand that the Ombudsman will not re-examine your medical condition or replace Medigold's medical opinion with their own. Instead, they will investigate "maladministration". They will check if the decision-makers: a) Properly followed the rules of the NHS Pension Scheme. B) Correctly looked at and weighted all the medical evidence you submitted. C) Acted fairly, without bias, and avoided unnecessary delays. D) Provided clear, full reasons for the refusal in plain language.
If the Ombudsman finds that the process was flawed, they will typically order the NHS Pension Scheme to completely rethink your application. They may also order compensation for any distress caused.

Free Help and Advice: If you need help wording your appeal or want to know what kind of additional medical evidence to gather, you can contact the The Pensions Ombudsman Early Resolution Team on 0800 917 4487. They offer free, independent advice before a formal complaint is filed. Alternatively, if you are a member of a trade union (like the RCN or Unison) or the BMA, their pensions caseworkers can assist you through this process."