Ill-health retirement appeal planner

What this planner does

If the Scheme Medical Adviser (SMA) has refused your ill-health retirement, or awarded the lower tier when you think the upper tier applies, you can appeal. The process has three stages and firm time limits, and the letters you get rarely explain where you are in it.

The free planner asks two questions, what you are appealing and where you are now, and then shows your deadline with a countdown, the time targets for your stage, whether there is a form to fill in, what happens next and what you can do. You can add the dates to your calendar with reminders.

It covers members of the Civil Service Pension Scheme, which includes prison officers and other HMPPS staff in England, Wales and Scotland. Northern Ireland Prison Service staff are in a separate NICS scheme.

Starting an appeal: form APP1 and the three-month limit

You appeal in writing by completing part one of form APP1 and returning it to your employer or former employer. Your employer must issue the form with their decision.

You must appeal within three months of the date your employer notifies you in writing about the content of the SMA's report. If you are appealing a refused retrospective application or early payment of a preserved classic pension, the three months run from the date you were told it was unsuccessful.

If you are too unwell to appeal yourself, a relative, friend or trade union representative can appeal on your behalf, with your consent, within the three months. If delays beyond your control mean you cannot meet the deadline, your employer may ask the Scheme Administrator to consider an extension.

The three stages, and why there is no stage three form

1. Stage one. Your employer sends the complete case file to the SMA with form APP1 part two. A physician, where possible the one who made the original decision, reviews the evidence plus anything new you sent. The SMA aims to clear stage one within 10 working days of receiving it.
2. Stage two. If the stage one physician does not support your appeal, they escalate it themselves. A senior physician with no earlier involvement checks whether a reasonable case exists and reports the initial review within 10 working days. Further evidence after that means a further review within 20 working days.
3. Stage three. Only if the SMA advises that a reasonable case has been made but doubt remains does the case go to an independent Medical Appeal Board. The SMA nominates a chair within five working days of stage two finishing, and you get at least two weeks' notice of a consultation where practicable.

So there is no form to apply for stage three. Progression is not automatic: the SMA decides whether a case goes to the Board. What moves a case forward is medical evidence, which is why the planner's paid pack focuses on it.

An appeal can be upheld at any stage. If the Board upholds ill-health retirement at the lower tier, that is final, with no further medical appeal on that point. After the medical appeal, the Internal Disputes Resolution procedure covers how the process was run, not the medical decision.

What medical evidence helps an appeal

You can appeal with or without new medical evidence, but the guide says that without it the case is unlikely to progress beyond stage two. If you are not sending new evidence, say so on the form.

Evidence would generally come from medical consultants. The SMA does not need their opinion on ill-health retirement itself. It needs clear medical information:

• a clear diagnosis (the SMA almost always needs one to assess the likely course of an illness);
• the treatment you have had, and how you responded to it;
• whether any treatment options remain;
• a clear opinion on the likely long-term outlook and the probable impact of future treatment.

If you are told there are gaps at stage two

At stage two the SMA may find deficiencies, most often gaps in the documents or a need for further medical evidence. Your employer must tell you immediately, and you have three months from that notification to put them right. Further evidence the SMA asks for is yours to source, provide and pay for.

If you cannot make a reasonable case within the three months, the appeal fails on procedural grounds. As with the first deadline, your employer may ask the Scheme Administrator for an extension if delays are outside your control. The planner works out this second deadline too.

What the paid appeal pack adds

The planner is free. The paid pack is part of the Ill-Health & Injury Benefit Report and adds the parts that take the paperwork off your hands:

• An evidence tracker that checks each report against the guide's rules: written within three months of your send date, complete, and not already considered.
• Five letters with your details filled in: the covering letter for form APP1, a request to your consultant for exactly what the SMA needs, a letter sending further evidence at stage two, a request for an extension, and a request for copies of your records.
• An appeal log of every letter, call and appointment, with dates, to download or print.