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Good Quality Evidence

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 01-04-2007.

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Good Quality Evidence

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  1. Good Quality Evidence Scottish Public Pensions Agency Presentations 2011

  2. Presentation Outline • The Relevant Regulations • What evidence makes a good application • Assessing for total incapacity • Reasons for refusal

  3. Two Tier Ill-Health Retirement Benefitsfrom 01-04-2007

  4. 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.

  5. 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

  6. 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 )

  7. Total Incapacity definition for TIB Reg E10AThe 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.

  8. 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

  9. 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!

  10. 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.

  11. Source: National Statistics

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  13. 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.

  14. 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.

  15. 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?

  16. STSS 2009-2010

  17. Reasons for rejection • Insufficient evidence of an incapacitating condition • Incomplete investigations • Incomplete treatment.

  18. 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?

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