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

STSS administrative changes effective from ▶ 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 PIB The Teachers’ Superannuation (Scotland) 2005 Amendment Regs 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 PIB Schedule 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) MalesFemales Years Proportion of life free from disability 79.9%81.3%78.2%78.7%

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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

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?