Tier 3 Ill health benefits cannot continue beyond three years. You will need to undertake a review when the pension payments for a member have been made for 18 months. We will let you know when the review is due. You must write to the member (see Sample Letter IHR 06) asking for details of their employment status to be declared on Form IHR 06. If, from the information provided, you decide that gainful employment had been obtained, the pension payments must stop.
If, as a result of your enquiry at the review, it is found that the employee has not found gainful employment, you are required to seek a further opinion from an IRMP concerning the condition which resulted in awarding Tier 3 Ill health benefits (unless the employee has already reached normal retirement age).
The same IRMP who signed the certificate that resulted in the first determination can sign the certificate (Form LGPS 17B) at the Tier 3 review. There is no requirement that the IRMP must be able to certify at the review that they have not previously advised, given an opinion on, or otherwise been involved in the case.
You must then decide whether to allow payments to continue, cease payments or to award Tier 2 benefits to the member from the date of the review decision.
Tier 3 Review Ill health medical certificates
Once the IRMP has made their medical opinion, they should complete the relevant certificate and return this to the employer.
The employer should use this certificate, along with any other supporting information, to make a decision on the pension entitlement. This includes determining which tier of Ill health award the member is entitled to.
You can use the following Ill health template letters to request the information needed for the 18 month review and tell an employee your decision
Additional Ill health costs
Any extra charge on the appropriate fund resulting from a member becoming entitled to benefits under regulation 35 (early payment of retirement pension on Ill health grounds) or 38 (early payment of retirement pension on Ill health grounds: deferred and deferred pensioner members) must be paid into the Fund by the Scheme employer. This will be built into the employer contribution rate rather than a direct strain cost.
Statutory guidance
2013 Regulation 36(4) makes it a requirement that both employers and independent registered medical practitioners have regard to statutory guidance when carrying out their functions.
The latest guidance is dated September 2014 and is accompanied by FAQs dated June 2015. Both documents are available under ‘Statutory guidance relating to the LGPS Regulations 2013’ section of the LGPS Regulations 2013 page. https://www.lgpsregs.org/schemeregs/lgpsregs2013.php