LGPS Tier appeal

[Tier2]

I was awarded tier 2 contrary to comprehensive reports from my own hospital consultants and general practitioner who stated not only was I permanently incapable of my own job, but would never be able to work more than 2.5 days in any job. My conditions are progressive.

I asked my employer for an explanation of why they chose to go with the IRMPs opinion, rather than my treating doctors. They said they are just going with the fact he ticked the tier 2 box on the M1. A more detailed report is not available from the IRMP.

I had thought it was actually the employees decision after weighing up all of the evidence and an explanation would be provided of how they reached their decision?

I have obtained Form A from the pension scheme. I have subsequently had a health assessment and been placed into the support group of ESA. I already received PIP. Nothing else has changed.

Any advice on how best to appeal?

I work for an LGPS fund.
Due to the regulations of the Scheme your employer has to use an IRMP, they cannot use your own doctors however the IRMP can liaise with your doctors.
Your employer has to go ahead with whatever tier the IRMP has indicated on the form.
You may appeal and go through the IDRP stage 1 procedure, however that does not appeal the tier. It looks into making sure the correct procedure was followed. If the IDRP finds that the correct procedure was followed and you still don’t agree you can take it to stage 2. Again, this will look at the procedure, not the tier. If after stage 2 you still wish to appeal you can go to the ombudsman, same thing only looks at the procedure.

I will just add that you haven’t given your medical issues or history but tier 1 is for people that will never work again, in any job or for any length of time.

@Polkadotties my dismissal letter states I can appeal the tier awarded.

I thought Tier 1 meant I was permanently unable to do the job I was retired from and unable to manage gainful employment, ie at least 30 weeks in any job. Where do the regulations state it’s never work again in any capacity?

www.lgpsregs.org/timelineregs/Statutory%20Guidance%20and%20circulars/CLG_IHGuide_June2011.pdf Section 29 point d
A tier 2 would be someone who probably won’t be able to have gainful employment in 3 years but most likely will before their NPA.
You may appeal but you employer has to go with the ill health certificate. All the appeal will do is examine the process. It’s not really an appeal to review the tier.

@Polkadotties thanks for further response. I have the 2014 regs and it appears to

state the final decision on tier is the employers not the IMRP however they must have the certificate.

How can it be fair to accept a decision without knowing the rationale behind it?

I can’t remember when exactly but the decision reg was reviewed recently. We’ve had a few members querying it and we double checked with the LGA who confirmed that the employer has to go with the IRMP.

@Polkadotties that’s interesting. I’m waiting for the pension fund to call me back so will ask. I do appreciate your input.

The Dept for Communities & Local Government FAQs 2014 states that the IRMP should set out why they disagree with my GP/specialist. They did not do this even though I did ask.

The employer doesn’t have to go with the IRMP certificate - if they do it is fettering their discretion. They have to get the IRMP certificate, then the decision is made using the certificate, the IRMP’s report and any other available evidence. The employer can however give the IRMP report more weight than, say, a report from the member’s GP.

Having said that, its almost unheard of for an employer to go against the IRMP report/certificate, but they should be able to evidence their decision making process and why they have followed the IRMP rather than anything else.

It does appear that your employer hasn’t followed the correct decision making procedure so you can definitely challenge that, but note that it doesn’t mean that they will change the final decision.

It definitely isn’t right that they’re saying there’s no report from the IRMP - there should be a report from the IRMP setting out why they came to the conclusion they did on the certificate and what evidence they used when coming to that decision. Your employer should then have read that report, and before making a final decision raised any questions with the IRMP (e.g if part of the file passed on to the IRMP included a report from your GP, but the IRMP report doesn’t mention it, I would expect your employer to be asking why the IRMP hadn’t mentioned it, in case it had been overlooked and changes the IRMP conclusions).

Polkadotties is right that the appeal process only looks at the decision making procedure rather than the medical evidence - but if the decision making process wasn’t carried out correctly it could mean that the case hasn’t been properly considered so looking at it afresh could mean a change of opinion. That isn’t always guaranteed though - I am aware of cases where ill health cases have been appealed and the decision considered afresh but the final result stayed the same.

@ChessieFL I have definitely been told, in writing, that no report was provided. I have only received the M1 which I believe is the certificate. The doctor has simply ticked boxes, there is no free text to say he had considered any of the medical reports submitted. I can see on the bottom of the M1 it states the final decision remains that of my employer. They have written and told me it is not their decision, it is the IRMPs decision based on the medical evidence provided.

When I appeal, is this under maladministration as a report was not provided and they haven’t followed the correct decision making process or something else?

Can I ask for reasons why the IRMP did not agree with my doctors and on what evidence he based his decision?

Is it worth submitting further medical evidence at this time?

You appeal that you don’t believe that the employer has carried out the decision making process correctly. Yes you can ask why the IRMP came to the conclusions he/she did and why their conclusions were different to your doctor’s.

You can submit additional medical evidence, but it should be relevant to the point at which the decision was made (so not things that have happened since) and the question then arises why it wasn’t submitted at the time?

If you go on the ombudsman’s website you can see lots of decisions made about LGPS ill health cases and you can see from these that only evidence that would or should have been available to your employer at the time can be considered, not ‘hindsight’ evidence.

Thank you @ChessieFL

Do they ever ask another IRMP for a second opinion? Is there a risk they may downgrade me to a Tier 3 if I appeal?

There might be a second opinion from another IRMP but you might have to go through a couple of stages of the appeal process - it doesn’t sound like your employer knows what they’re doing so it’s possible that they won’t uphold the first stage of the complaint and you will have to go to stage 2 at which
point I would expect the pension fund to tell them to have another go. Usually that would involve another IRMP opinion but depending on the facts of your case it might be sufficient for the original IRMP to provide a detailed report of his/her conclusions.

In theory it is possible that a subsequent IRMP could certify tier 3 but that sounds very unlikely in your case.

Is stage 2 a complaint to the pension fund? At what stage would I consider a complaint to the Pensions Ombudsman?

I really do not want to risk a Tier 3 as it’s much less money.

Yes, at stage 2 the pension fund would review the complaint. If you’re still not happy after stage 2, then you go to the ombudsman.

I’ve seen a lot of ill health appeal cases and I’ve never heard of anyone being downgraded from the original tier. As I said it is theoretically possible, but if it did happen I would expect the employer to stick with the original tier in that case.

Hi, did you ever get the overturned? I’m on a similar position at the moment and would appreciate any advice