Medical Certificate for Current Tier 3 Pensioner
Review within 3 years of Ceasing Employment
(where employment ceased after 31.03.2014)
The person named below in Section 1, was awarded a short-term, reviewable, Tier 3 Pension. It is now necessary to
review, in accordance with regulation 37 of the Local Government Pension Scheme (Benefits, Membership and
Contributions) Regulations 2013, whether he/she is still capable of undertaking gainful employment within three years of
the ‘Date the Former Employment Ceased’.
Section 1 – Member’s Details (to be completed by the Former Employer)
Name of Member
Former Employer
Former Job Title
Home Address
National Insurance number
Date Former Employment Ceased
Date of Birth
Section 2 - Medical Practitioner’s Certification
This section must be completed by an approved independent doctor “qualified in occupational health medicine” and
registered with the General Medical Council, providing an opinion on the person’s capability of discharging the
duties of their normal occupation, and their capability of undertaking gainful employment based solely on the effect
the medical condition has on the ability to undertake gainful employment.
Part 1 - Please tick one box only
A
B
1The
I certify that in my opinion this employee is not permanently incapable1 of discharging
efficiently the duties of his/her normal occupation by reason of ill health or infirmity of
mind or body.
OR
I certify that in my opinion this employee is permanently incapable1 of discharging
efficiently the duties of his/her normal occupation by reason of ill health or infirmity of mind or
body.
If ticked
go to
Section 4,
page 3
If ticked
go to
Part 2,
below
LGPS regulations define “permanently incapable” to mean “that the member will more likely than not, be
incapable until, at the earliest, his/her Normal Pension Age (NPA3”).
Part 2 - Please tick one box only
C
I certify that, in my opinion, the person named in Section 1 is currently capable of
undertaking gainful employment2.
If ticked
go to
Section 4,
page 3
OR
D
E
I certify that, in my opinion, the person named in Section 1 is not likely to be capable of
undertaking gainful employment2 within three years of the date their former
employment ceased shown in Section 1 (or by Normal Pension Age NPA3, if earlier).
If ticked
go to
Section 3,
page 3
OR
I certify that, in my opinion, the person named in Section 1 is still likely to be capable of
undertaking gainful employment2 within three years of the date their former
employment ceased shown in Section 1 (or by Normal Pension Age NPA3, if earlier).
If ticked
go to
Section 4,
page 3
The expression “gainful employment” is defined in the LGPS regulations as “paid employment for not less than
30 hours in each week for a period of not less than 12 months”.
2
3NPA
means the member's Normal Pension Age under the 2014 Scheme which is linked to the member's State
Pension Age (SPA) but with a minimum of age 65.
Section 3 - Certification for the Severe Ill Health Test (Please tick one box only)
This section is a general statement required by Her Majesty’s Revenue & Customs (HMRC) which must be
completed by the Medical Practitioner. The answer to this question is used to determine whether or not the person
could be subject to a tax charge in accordance with the annual allowance test under the Finance Act 2004. State
Pension Age (SPA) is currently age 65 for men. SPA for women is currently being increased to be equalised with
that for men. The Government has announced that it will speed up the pace of SPA equalisation for women; so
that women’s State Pension Age will reach 65 by November 2018. The SPA will then increase to 66 for both men
and women from December 2018 to October 2020. Under current legislation the SPA is due to rise to 67 between
April 2034 and April 2036 and to 68 between April 2044 and April 2046. For a full breakdown of State Pension
Ages please see: http://www.pensionsadvisoryservice.org.uk/state-pensions/state-pension-age-calculator
I further certify that, in my opinion, the person does satisfy the following
statement:
D
‘As a result of his/her ill health or infirmity, the employee was unable to continue in
his/her current job and is unlikely to be capable of taking on any other paid work in
any capacity, otherwise than to an insignificant extent4 before State Pension Age.’
OR
Now
go to
Section 4,
below
I further certify that, in my opinion, the person does not satisfy the following
statement:
E
‘As a result of his/her ill health or infirmity, the employee was unable to continue in
his/her current job and is unlikely to be capable of taking on any other paid work in
any capacity, otherwise than to an insignificant extent4 before State Pension Age.’
4‘Insignificant
extent’ means, for example, that the person could undertake voluntary work or unpaid work where out of
pocket expenses are reimbursed or small amounts of travelling or subsistence payments are made. Any paid work
should be insignificant, for example it should be infrequent or only for a few days during the year and the payment must
be small in amount, not just as a proportion of the pay or salary they are earning in their current job.
Section 4 - Medical Practitioner’s Declaration
I certify that I am registered with the General Medical Council and I hold a diploma in occupational
health medicine (D Occ Med) or an equivalent qualification issued by a competent authority in an EEA
State (with ‘competent authority’ having the meaning given by Section 55(1) of the Medical Act 1983),
or I am an Associate, a Member or a Fellow of the Faculty of Occupational Medicine or of an equivalent
institution in an EEA State and I have given due regard to the guidance issued by the Secretary of
State when completing this certificate.
Signature (Medical Officer)
Please Print Name
Date
Medical Officer’s Stamp
Section 5 – Employer’s Determination
Determination Date
After submission of the Medical Practitioner’s Certification, I declare that on the Determination Date,
shown above, a decision was made to:
Cease payment of the Tier 3 ill health pension to the person from*:
Award an enhanced Tier 2 ill health pension to the person from:
Continue payment of the Tier 3 ill health pension for the remainder of the 3 years from when the person’s
former employment ceased.
*Please can you provide details of the period and amount of the resultant overpayment of pension.
Signature
Designation
Please Print Name
Department
Date