Ill health: case 1

Mrs A went on long-term sick leave when she was in her mid-40s.  Her pension scheme’s rules said that she needed to be permanently incapacitated in order to receive a pension.

In her case this meant she would have to be unable to work in gainful employment until she reached 65, when she would normally have retired.

Six months after she went off sick and while she was still employed, a medical adviser to her employer said it was too soon to say that she was likely to remain unfit for her work until age 65.

He said there was a reasonably good prospect that her condition would eventually improve sufficiently for her to return to gainful employment.

Her employer accepted the medical adviser’s recommendation and terminated her employment, refusing her an ill-health pension. Mrs A appealed saying that she should qualify for the pension.

A report from her rheumatologist said that, although there were a number of treatment options, none would be expected to cure her condition and it would not be possible to reliably predict permanent incapacity at that stage.

Another report said her condition was unlikely to improve to the extent that she would be able to work during the next three years, but she might make a recovery of some sort in due course.

The employer’s medical adviser read the reports. He didn’t see Mrs A personally and said there was a reasonable prospect of Mrs A being able to return to work in the longer term.

He noted that she was only in her 40s and further treatment options might be available. Her employer turned down Mrs A’s appeal on the basis that she had not exhausted all treatment possibilities.

We upheld the complaint.

Mrs A said that the medical adviser should have examined her, however we decided that was a matter for the adviser’s judgment.

But the decision to reject her application on the grounds that there might be untried treatments that might help her return to work was not a proper one, because the employer needed to look at what was likely to happen, not what might.

The employer should have found out whether there were future treatment options and, if any were identified, it should have considered whether Mrs A’s ill health was likely to be permanent if those treatment options were undertaken.

We told the employer it should make a new decision, directing it to obtain any further reports it might need. We also said that the employer should pay Mrs A £200 to compensate her for the inconvenience of having to go through the process twice.