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Failure to seek clarification on ill health – The case study of Mr N

Complaint Topic: Ill health
Outcome: Upheld
Type: Pension complaint or dispute

In January 2017, Mr N applied to NHS Pensions for early payment of his deferred benefits on the grounds that he was suffering from chronic depression and anxiety. 

Mr N complained to the Ombudsman that his application on the grounds of ill health had not been considered properly. 

In part one of the application form Mr N entered “None” under consultant details. However, his GP completed part two and stated that he had seen a psychiatrist and provided their name and contact details.

Mr N was reviewed by an NHS Pensions medical advisor (MA) who considered Mr N capable of regular employment of a like duration to his former NHS employment. The MA also considered he should respond well to psychological and cognitive behavioural therapies and changes to his anti-depressant medication.

In July 2017, Mr N appealed. NHS Pensions obtained the opinion of another MA, but he had similar views to the first, that suitable psychological and behaviour therapy coupled with medication and lifestyle changes would help.
Neither MA had sought input from the psychiatrist seen by Mr N. As Mr N’s psychiatrist had not been contacted, it was not clear if any of the suggested treatments had been tried or were considered unsuitable. It was also not clear from the opinions why it was felt Mr N would respond well to treatment. 

The Deputy Ombudsman upheld Mr N’s complaint as NHS Pensions should have sought clarification before relying on the opinion of the MAs. 

She directed NHS Pensions to request details of the treatment Mr N had received and the psychiatrist’s prognosis on his mental health condition. Following this, the MA should carry out a further assessment on Mr N’s eligibility for ill health retirement. NHS Pensions were also directed to pay Mr N £500 for the distress and inconvenience caused.

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