Ill health

Our approach

When someone complains that they haven’t been awarded the ill health (or incapacity) pension they think they should get, we look at the way that the decision has been reached.

We don’t look at the medical evidence and make our own decision based on it, nor do we obtain our own medical reports.

The test that we use is whether the people making the decision have gone about it in the right way and have made a decision that can be regarded as reasonable.

Who might be at fault?

Different pension arrangements have different rules about ill health pensions.  For example sometimes the decision will be made by the employer, sometimes by the scheme’s trustees or managers, or by a combination of all of those people.

We will look to see whether the right body has made the decision.

What we look at

We will look into whether the decision makers have used their powers in a way that is consistent with the scheme’s rules or regulations.

That means they will need to know what their powers are and in particular what the test for the payment of a pension is.

For example, the scheme rules might be that the person cannot continue in their present job. Or they might be a much stricter test about whether someone can do any work at all.

We will also consider whether the decision makers have looked at all the relevant evidence, and not taken anything into account that was irrelevant.

For example they will need to take account of the medical evidence and reports, though they can decide which to follow if the medical experts disagree.

Overall we will decide whether the decision makers have reached a decision that makes sense based on the evidence. We don’t have to agree with them. We just have to decide whether they followed the correct process.

We can also look things such as whether the process took the right amount of time or the person applying was kept informed.

What happens if the complaint is upheld

If we think the decision makers have gone about reaching their decision in the wrong way we will usually order them to make a fresh decision. We may want them to obtain more evidence or take other steps first.

We may also require them to pay a sum in compensation for any non-financial injustice, such as distress or annoyance [see ‘Putting Things Right’].