SUPERANNUATION ACT 1972

LOCAL GOVERNMENT PENSION SCHEME REGULATIONS 1997 (the 1997 regulations)

1. I refer to your letter dated 31 May 2000 in which you appeal (under regulation 102 of the 1997 regulations), on behalf of Mrs XXX, to the Secretary of State for the Environment, Transport and the Regions against the decision of Ms XXX, the Appointed Person for XXX (the council), in relation to her local government pension scheme (LGPS) dispute with the council.

2. The Appointed Person found that “In the circumstances my decision about [Mrs XXX’s] complaint is that at this stage I do not uphold it. [Her] health appears to fluctuate.”

3. Question for decision: The question for decision by the Secretary of State is whether Mrs XXX ceased employment with the council by reason of being permanently incapable of discharging efficiently the duties of her former employment because of ill-health or infirmity of body or mind, and so qualifies for immediate payment of her LGPS benefits.

4. Secretary of State’s decision: The Secretary of State has considered all the representations and evidence, and has taken into account the appropriate regulations. He finds that there appear to be different medical opinions and these have not been explained or resolved to his satisfaction. He has therefore decided to refer the matter back to the council for them to refer all the evidence to a separate, independent registered medical practitioner qualified in occupational health medicine who has not been involved with the previous decisions.

5. The Secretary of State’s decision replaces that made by the Appointed Person.

6. The Secretary of State’s reasons and the regulations which he considers apply in this case are set out in the annex to this letter, which forms an integral part of the decision. He is acting judicially and has no power to modify the way the regulations apply to the facts of the case. Having made his decision he has no power to alter it and his officials cannot discuss the case further or enter into any further correspondence with you about the decision. The decision is binding and can only be overturned by a judgement of the High Court or the Pensions Ombudsman.

7. This completes the second stage of the internal dispute resolution procedure. The Pensions Advisory Service (OPAS) is available to assist members and beneficiaries in connection with difficulties which they have failed to resolve. Their address is 11 Belgrave Road, London, SW1V 1RB (telephone 020 7233 8080).

8. The Pensions Ombudsman may investigate and determine any complaint of maladministration or any dispute of fact or law made or referred in accordance with the Pensions Scheme Act 1993. His address is 11 Belgrave Road, London, SW1V 1RB (telephone 020 7834 9144).

EVIDENCE RECEIVED

1. The following evidence has been received and taken into account:

a) from you: letter dated 31 May 2000 (with enclosures); and

b) from the Appointed Person: documents considered by her (list enclosed with the Department’s letter dated 11 July 2000).

THE SECRETARY OF STATE’S POWERS

2. The Secretary of State’s powers under regulations 102 and 103 of the 1997 regulations are to reconsider the original disagreement you referred to the Appointed Person under regulation 100. This regulation refers to a matter relating to the LGPS, which effectively means whether the statutory provisions governing the LGPS have been correctly applied in the circumstances. The Secretary of State has no powers to direct the council to act outside the provisions of the regulations.

REGULATIONS CONSIDERED AND REASONS FOR DECISION

3. From the evidence the following points have been noted:

a) Mrs XXX’s date of birth is 16 October 1947;

b) she was employed by the council as a Social Worker;

c) she was a member of the LGPS;

d) Mrs XXX suffered an illness that resulted in extended periods of sick leave;

e) the council refused to grant her ill-health retirement on 10 August 1998 based upon the recommendations of Dr XXX;

f) her employment was terminated on 30 September 1998 on the grounds of medical incapacity;

g) Mrs XXX was referred to a further independent medical adviser;

h) the council refused to grant her ill-health retirement following the report from Dr XXX; and

j) Mrs XXX appealed to the Appointed Person against the council’s decision not to award her ill-health retirement.

4. Mrs XXX maintains that she is permanently incapable of performing the duties of her former employment or any employment and contends that there is evidence to show this. She contends that the medical report from Dr XXX was overruled by the Occupational Health Physician and the Appointed Person.

5. The Appointed Person determined that “… I am aware from your file that you are 52 years of age and therefore would still have an expectancy of a working life for another 7 to 8 years. It is this issue which causes me difficulty given the comments from Dr XXX gleaned from recent reports supplied to her that some improvement is already being made in your condition. In the circumstances my decision about your complaint is that at this stage I do not uphold it. Your health appears to fluctuate.”

6. The Secretary of State notes that Mrs XXX has been awarded incapacity benefit. He takes the view that benefits awarded by the DSS are not conclusive in determining the award of LGPS benefits, as the tests to be applied are different.

7. The Secretary of State notes that the Appointed Person has made reference to comparable employments, however reference to “comparable employment” was not introduced into the 1997 regulations until 1 April 1999. As Mrs XXX’s employment was terminated on 30 September 1998 and she is seeking to have her benefits paid from that date this amendment does not apply to her.

8. The Secretary of State in reaching his decision has had regard to the regulations, which, in his view apply. He notes that the Appointed Person has erroneously made reference to section D of the 1995 regulations, which deals with retirement benefits for members who ceased employment prior to 1 April 1998. Mrs XXX ceased employment on 30 September 1998, such members who were contributing members of the LGPS on 1 April 1998 are subject to the 1997 regulations in relation to their benefits. Regulation 27 of the 1997 regulations provides for a member's pension and retirement grant to be paid immediately, with enhancement where applicable, where they cease employment because they are permanently incapable of performing their former duties efficiently due to ill-health or infirmity of mind or body.

9. The Secretary of State takes the view that for her incapacity to be permanent it would have to be unlikely to improve sufficiently for Mrs XXX to perform the duties of her former employment efficiently before her normal retirement age when LGPS benefits must, in any case, be paid. Taken together, the Secretary of State accepts that the medical evidence shows that Mrs XXX suffers from the condition fibromyalgia. He also accepts that at the time she was dismissed, the medical evidence indicates that Mrs XXX was incapable of efficiently performing her duties.

10. The Secretary of State notes that, in her letter dated 26 July 1998, Dr XXX stated “…regrettably there is no evidence at the moment that she will never recover fitness to return to her job until retirement age, and I therefore cannot support permanent ill-health retirement. …I recommend that her employment is terminated on grounds of medical incapability; she would be eligible for requesting early introduction of deferred benefits if her condition proves to be permanent.” He notes that Ms XXX wrote to Mrs XXX, on 10 August 1998, informing her that due to Dr XXX’ recommendation the council had decided to terminate her employment from 30 September 1998 on the grounds of medical incapability. He notes that Dr XXX stated that she did not take Mrs XXX’s specialist’s report into consideration when providing her opinion in the letter dated 26 July.

11. The Secretary of State noted that Consultant Rheumatologist Dr XXX, in his report dated 23 March 1999, stated “Although symptoms of Fibromyalgia may be variable there is no doubt that this is a chronic condition for which there is no known effective treatment. …I would anticipate that any return to work would aggravate and intensify her symptoms and cause a deterioration in her Fybromyalgia Syndrome. Accordingly I think it would be reasonable to consider Mrs XXX to be suffering from permanent ill-health as any significant recovery is unlikely.” The Secretary of State notes that Dr XXX considered correspondence from Mrs XXX’s General Practitioner and Dr XXX.

12. The Secretary of State notes that Mrs XXX appealed against the council’s decision and the council subsequently referred her to Dr XXX for a further medical opinion. Dr XXX, in his report dated 10 November 1998, stated “…my view, based on the nature of these relapsing conditions, [Mrs XXX’s] sickness pattern during the last 2-3 years, is that on the balance of probability she is unlikely to hold down any job effectively into the foreseeable future and that her incapacity is for all practical purposes permanent.” The Secretary of State notes that the council refused to grant Mrs XXX ill-health retirement, although a copy of the letter informing Mrs XXX of this was not submitted to him he notes that Mrs XXX wrote to Mr XXX on 11 December 1998, stating “…my retirement on the grounds of ill-health has not been accepted and the decision regarding the termination of my employment on the grounds of medical incapacity stands.”

13. The Secretary of State notes that the Appointed Person sought Mrs XXX’s authorisation to seek up to date medical reports from her General Practitioner, which were referred to Dr XXX. Dr XXX, in her letter dated 16 December 1999, stated “…I remain of the opinion that Mrs XXX may at some stage recover fitness to return to work, including the duties of Social Worker or comparable. I am however aware that a few [percent] of people with fibromyalgia, especially if they have suffered from chronic syndrome/ME in the past, have a poor prognosis; I would therefore think it fair to monitor Mrs XXX’s situation on an annual basis for perhaps the next 3 to 4 years. I remain unable to recommend the release of her pension.” The Secretary of State notes that Dr XXX does not appear to have considered Dr XXX’s report dated 23 March 1999 in providing her opinion. Dr XXX stated “…it seems that I will not be receiving any further information from Dr XXX, as I am now led to believe that he hasn’t seen Mrs XXX since the initial visit in July 1998.” He notes that Dr XXX’s report dated 23 March 1999 was based upon an examination of Mrs XXX on 11 March 1999.

14. The Secretary of State notes that no further medical opinion has been offered which specifically addresses whether Mrs XXX is permanently incapable by reason of ill-health of performing the duties of her previous employment.

15. The Secretary of State considers that there is a conflict of medical opinion on the issue of permanency between, on the one hand, Dr XXX, and on the other, Dr XXX and Dr XXX and the reasons for this have not been explained to his satisfaction. The council appear to prefer the medical view submitted by Dr XXX and have not explained why. The evidence suggests that Dr XXX and Dr XXX are the only independent medical advisers qualified in occupational health who have provided an opinion on the permanency of Mrs XXX’s medical condition. It appears that in making her recommendations Dr XXX may not have taken account of the full opinion of Dr XXX.

16. The Secretary of State does not consider that referring the case back to Dr XXX has done anything to resolve the conflict of medical opinion and he also believes that, as Dr XXX had already been involved in the initial decision, an independent view would be more helpful at this stage in trying to resolve this conflict. He has therefore decided to refer the matter back to the council for them to arrange for an independent registered medical practitioner qualified in occupational health medicine, who has not been involved in the previous decisions, to review all the medical evidence, with an examination if necessary; and that they should answer the specific question: when Mrs XXX ceased employment on the grounds of medical incapacity, was she permanently incapable of discharging efficiently the duties of that employment because of ill-health or infirmity of mind or body.