On pages 13 to 15 of this form, there is a guide for members applying for incapacity benefits.
PM30 Railways Pension Scheme (also used for British Railways Superannuation Fund)
A guide for members applying for
incapacity benefits
Stage 1 - Before the medical assessment
The employer should advise the member that his or her incapacity may be sufficient to terminate employment but may not
meet the qualifying criteria within the rules for an incapacity pension, and also provide a copy of the leaflet which is
attached to this form.
The member must have five years’ Scheme membership (including any transferred membership or transferred railway
pensionable service) before an application can be made.
Section A of the form should be filled in by the member applying for incapacity benefits.
Section B of the form should be filled in by the employer.
Once sections A and B have been filled in, the form should be sent, together with the sickness absence record and job description, to
the Medical Examiner who will undertake the medical assessment. The Medical Examiner should normally be an Occupational Physician.
Stage 2 - After the medical assessment
Section C should be filled in by the Medical Examiner who has undertaken the medical assessment.
After the medical assessment, the form and Medical Examiner’s supplementary report must be sent to RPMI.
Qualifying criteria
The Pensions Committee must be satisfied that the member meets the criteria laid down in the Scheme’s definition of
incapacity. These include:
(a) the member must suffer from bodily or mental incapacity or physical infirmity;
(b) the incapacity or infirmity must be such as to prevent the member from performing his or her duties other than temporarily; and
(c) the incapacity or infirmity must be such as to prevent the member from performing any other duties other than temporarily, which in the opinion of the Pensions Committee are suitable for the member.
Strictly confidential
Please use BLOCK CAPITAL letters (to be completed by the member).
To be filled in by the member before a medical assessment is carried out. Please read carefully the questions and answers
leaflet attached to this form before continuing. (Please print.)
Section A - Medical information, skills, qualifications, work experience and declaration of the member
Name in full:
Pension reference number:
Address:
Postcode:
Daytime phone number:
Payroll number:
PM30/version2/21.02.17
1 of 15
Section A - continued
Name of family doctor (GP): Name of hospital specialist (if applicable):
GP’s address: Hospital specialist’s address:
Postcode: Postcode:
GP’s telephone number: Hospital specialist’s telephone number:
Hospital registration number:
Please provide the information requested below which will be used to help assess your suitability to do ‘other
duties’. Note: You can attach the following information to this form and sign it if this is easier.
Please tell us your skills eg. computer literate, project management, supervision, manual labour:
Please tell us your qualifications:
Please tell us your previous work experience, stating company, job title and main duties:
Please tell us if you believe there is any type of work (inside or outside of the railway industry) that you would now,
or in the future, be capable of and suited to doing, and describe it. If you don’t think that there are any types of work
which you would be capable of and suited to doing, please explain in detail why you think this is the case:
PM30/version2/21.02.17
2 of 15
Section A - continued
Member’s declaration
Alternative benefits (early retirement)
I understand that if my application for incapacity benefits is successful I will no longer have the right to apply for early retirement
benefits which provide a lower level of benefits but cannot reduce or (stop which may occur for incapacity benefits - see below).
I understand an Annual Allowance charge may apply to my ill-health retirement benefits, (please see page 10).
Continuation of incapacity pension
I understand that if the Pensions Committee grants incapacity benefits it has the right to reduce or stop my incapacity pension
before Normal Pension Age ­­(normally age 60**) on any terms it decides are relevant to assessing my continuing eligibility for
incapacity benefits. This is most often done if:
•
•
the Pensions Committee asks for a medical review after the pension is granted and the review finds that I have recovered
sufficiently enough to be able to earn an income; or
I return to work. In this situation I understand that a financial review will be carried out to assess my total earnings and, if necessary, my incapacity pension will be reduced or stopped.
In both cases, I note that the full incapacity pension will be paid to me from my Normal Pension Age. Before then, I understand
that I will be expected to co-operate with any review when necessary and that my pension may be suspended if I do not co-operate.
Collection of evidence
I understand that in connection with my application for incapacity benefits, the Pensions Committee may wish to make
enquiries about my health and ability to work, including any or all of the following actions:
1.To have access to my occupational health record held by my employer’s occupational health adviser.
* 2.To correspond with my family doctor for the purpose of obtaining a medical report and/or have access to my medical record.
* 3.To correspond with any hospital or other specialist to whom I may have been referred, to get a medical report and/or have access to my medical record.
4.To refer me to my employer’s Medical Examiner and/or the Pensions Committee’s Medical Adviser for the purpose of medical assessment and production of a report on the medical aspects of my application to the Pensions Committee.
5.To refer me to a specialist by my employer’s Medical Examiner and/or the Pensions Committee’s Medical Adviser for the purpose of an independent medical assessment.
6.To correspond with my current employer to find out information concerning the nature of my employment.
I agree and consent to any or all of these actions and confirm that any medical report or other relevant medical information,
obtained for the purpose of assessing my application, can be disclosed to the Pensions Committee and RPMI in order to help them
assess my application.
* If a report is requested you will be notified; please tell us if you require prior access to the report. (Please tick): yes
no
** A higher age than 60 for normal retirement benefit applies for some members (please check with RPMI if you do not know
your normal retirement age).
To comply with the requirements of HMRC, can you please confirm if, in the six years leading up to your request for payment of a lump sum on the grounds of ill health, you have:
a) Been a director or a person connected to a director in relation to the sponsoring employer or an associated employer
(please tick): yes
no
b) Either alone or with others been the sponsoring employer of the Section (please tick): yes
no
or
c) Been a person connected with the sponsoring employer (please tick): yes
no
If you answer yes to any of the above, we are required to report the payment to HMRC.
Data Protection
I understand that my personal and medical information will only be used for the purpose of assessing my application for
incapacity benefits and any future review of my continuing eligibility for incapacity benefits.
Your signature:
Date:
/
/
PM30/version2/21.02.17
3 of 15
Please use BLOCK CAPITAL letters (to be completed by the employer).
To be filled in by the employer before a medical assessment is undertaken.
Section B - Details of the member and declaration of the employer
Note: You can attach the following information to this form and sign it if this is easier.
Title: (please specify)
Mr Mrs Miss Payroll number:
Other
First names:
Surname:
Date of birth:
Date entered service:
/
/
/
/
Normal Pension Age of member:
Current job title and detailed description of duties including position within the company (for example,
team member, supervisor, manager). Job description to be included:
Previous job titles and description of duties within the company:
Please tell us if there is any type of work within your company that the member could do and for which they
would be suited (assuming a vacancy existed) and provide a description of the duties involved in this role.
Please provide details of restrictions/reasonable adjustments made to current job role.
Date last period of absence started:
/
Date sick pay stopped (or will stop):
/
/
/
Please provide copy of sickness absence record for the last 2 years.
Date member left service (or will leave):
/
/
Indicate the grounds on which the member has left (or will leave) your company’s service. (Please tick.)
Ill health severance
Voluntary/compulsory redundancy
Early retirement/resignation
PM30/version2/21.02.17
4 of 15
Section B - continued
Place of employment:
HR contact:
Employing company:
Telephone number:
Address:
Postcode:
Employer’s declaration:
I confirm that the information given above is correct and that arrangements have been made to fill in and send an
‘Application for payment of benefits’ form.
Name (print):
Signature of authorised signatory:
Position (print):
Date:
/
/
Note: Please send the ‘Application for payment of benefits’ form to RPMI when you send this form to the Medical Examiner,
so that payment of benefits can be made promptly if the Pensions Committee approves the application.
Section C - Medical assessment and declaration of the Medical Examiner
To be filled in by the Medical Examiner undertaking the medical assessment and returned to RPMI, together with a supplementary
report. The following questions should be answered with the qualifying criteria on the front page in mind.
1. Briefly describe the member’s incapacities, including their duration:
2. In your opinion, is the member’s incapacity
more than a temporary condition? (Please tick):
yes
no
currently uncertain
prognosis
3. In your opinion, is the member fit enough to
perform his or her own duties? (Please tick):
yes
yes (in the
next year)
currently uncertain
prognosis
no
(never)
4. In your opinion, is the member fit enough to
perform any other duties? (Please tick):
yes
yes (in the
next year)
currently uncertain
prognosis
no
(never)
5. Does the member meet HMRC incapacity
criteria? (Please tick):
yes
no
HMRC’s current description of ill-health retirement is that ’the member is not able to continue in their current job and is not likely to
be able to take any other paid work to the extent that is significant. For example, the member 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
work should be insignificant; for example, it should be infrequent or only for a few days during the year and payments must be small in
amount, not just as a proportion of previous pay or salary.’
PM30/version2/21.02.17
5 of 15
Section C - Medical assessment and declaration of the Medical Examiner
6. Please provide basic details of the member’s current capabilities:
yes
no
comments
Normal vision and not colour blind
Normal hearing
Normal speech
Normal balance
Normal stamina
Normal memory and concentration
Dominant hand fully functional
Able to read and write English
Able to do basic arithmetic
Able to drive a car
Able to work at heights
Able to work in confined spaces
Able to lift and carry, bend and kneel
Able to deal with public
Fit for manual handling
Fit for safety critical work
Fit for work requiring mobility
Fit to travel to/from work
Other physical disabilities
Other mental disabilities
7. Please tick category of illness (as set out in ICD10 - used for statistical analysis):
Certain infectious and parasitic diseases
Diseases of the digestive system
Neoplasms
Diseases of the skin and subcutaneous tissue
Diseases of the blood and blood-forming organs
and certain disorders involving the immune
mechanism
Diseases of the musculoskeletal system and connective
tissue
Diseases of the genitourinary system
Endocrine, nutritional and metabolic diseases
Pregnancy, childbirth and the puerperium
Mental and behavioural disorders
Certain conditions originating in the perinatal period
Diseases of the nervous system
Diseases of the eye and adnexa
Diseases of the ear and mastoid process
Congenital malformations, deformations and
chromosomal abnormalities
Symptoms, signs and abnormal clinical and
laboratory findings, not elsewhere classified
Diseases of the circulatory system
Diseases of the respiratory system
Injury, poisoning and certain other consequences of
external causes
PM30/version2/21.02.17
6 of 15
Section C - continued
8. Please send this form to RPMI together with the enclosed supplementary report which gives full details of the
member’s incapacities, their duration and likely prognosis for a full or partial recovery, taking into account
whether all reasonable treatment options have been explored. Please tell us if you believe there is any type
of work (inside or outside of the railway industry) that the member would now, or in the future, be capable
of and suited to doing. Describe it with as much detail as possible (taking account of information contained in
Sections A and B of this form) and note that a member who was in full-time employment would need to be able
to return to full-time employment. If you don’t think that there are any types of work that would be suitable for
the member now, or in the future, please explain in detail why you think this is the case:
Print name: Name and address stamp:
Signature: (authorised Medical Examiner)
Date:
/
/
PM30/version2/21.02.17
7 of 15
Please send this form to: RPMI, PO Box 300, Darlington, DL3 6YJ
PM30/version2/21.02.17
8 of 15
Application for Incapacity Benefits – Railway Pensions Scheme Supplementary Report to Section C of PM30 form
This report should be completed by an Occupational Physician with experience and knowledge of Railway Industry
Occupational Health and the report should be based on the findings of an objective clinical assessment.
Date of assessment and report:
/
/
Details of the Employee/Member
Surname:Forename:
Title:
Date of Birth:
/
/
Occupation:Employer:
1. Evidence considered:
List the evidence considered giving name of their authors and dates e.g. GP and specialist report/s and previous OH report/s.
2. Relevant medical details:
Please outline all the medical and psychological health problems/conditions including:
a)Diagnosis:
b) Relevant clinical examination findings:
c) Outcome of investigations to date:
PM30/version2/21.02.17
9 of 15
Application for Incapacity Benefits – Railway Pensions Scheme Supplementary Report to Section C of PM30 form
d) Treatment received to date and its effectiveness
3. Current symptoms and functional capacity/limitations
Please outline:
a) Current symptoms, functional capacity/limitations and impact on daily and work activities
b) Extent of any disability/incapacity resulting from the condition/s
c) Proposed plan of treatment / interventions. Are these likely to significantly improve functional capacity?
d) Likely prognosis
4. Fitness for work and prognosis of recovery
Provide reasons and information to support your response to the following questions.
YES
NO
a) Is the individual currently fit to undertake his/her normal duties?
b) Is the individual currently capable of undertaking suitable alternative duties (not confined to the railway industry)?
c) Is the future treatment likely to significantly improve functional capacity?
PM30/version2/21.02.17
10 of 15
Application for Incapacity Benefits – Railway Pensions Scheme Supplementary Report to Section C of PM30 form
YES
NO
d) If the future treatment is likely to improve the condition, will he/she be able to return
to the normal role prior to his/her Normal Retirement Age and provide regular and
effective service?
e)
If the future treatment is likely to improve the condition, will he/she be able to return
to alternative duties (within and outside the railway industry) prior to his/her Normal
Retirement Age and provide regular and effective service? If he/she can undertake
alternative work, please indicate below the nature of duties that he/she can do?
Any other information that may be relevant to his/her pension application:
Name, qualifications, GMC Number and signature, of the Occupational Physician.
Name of the Occupational Physician:
Qualifications:
GMC Number:
Name of the Occupational Health
Service Provider:
Signature:
PM30/version2/21.02.17
11 of 15
PM30/version2/21.02.17
12 of 15
Please read this leaflet carefully before applying for incapacity benefits and keep it safe
for future reference
A guide for members applying for
incapacity benefits
Our promise to you
However long it takes to consider your application, we promise
that the aim is only to be sure that the Pensions Committee
has enough information to decide if you are entitled to an
incapacity pension under the rules of the Scheme.
We promise to keep you up to date with the progress of your
application.
In this leaflet we answer the questions which you are likely
to ask. Keep the leaflet handy as you may want to refer
to it while your application is being processed. If you have
any further questions regarding your incapacity benefits
application or need further assistance on completing this form,
please ring the Helpline on 0800 2 343434.
Do you have to give up work because of illness or incapacity?
When members become too ill to carry on working, the Railways Pension Scheme may be able to provide an incapacity pension to
help make up for the loss of income. The pension is paid to those who meet the Scheme’s requirements, which includes the need for
the Pensions Committee to be satisfied that your medical condition meets the definition of ‘incapacity’ in the rules which govern the
operation of the Scheme.
Because of this, it can take some time for enough information about your medical condition to be gathered together, so please
be prepared for this. In some cases, decisions on applications can be made quickly, but in others it can take some months,
especially if a doctor or specialist needs to wait to see how your condition progresses, or responds to treatment.
Please note that even if your employer releases you on ill-health grounds, this is no guarantee that you will receive an incapacity
pension from the Scheme.
Your questions answered
Q What does ‘incapacity’ mean in
A
the Scheme’s rules?
The rules are part of the legal
documents which govern the
Scheme so the Trustee Company
must stick to them. In the Railways
Pension Scheme rules, ‘incapacity’
is defined as “bodily or mental
incapacity or physical infirmity
which, in the opinion of the Trustee
Company on such evidence as it may
require, shall prevent, otherwise than
temporarily, the member carrying
out their duties, or any other duties
which in the opinion of the Trustee
Company are suitable for them.”
The definition of ‘incapacity’ is
different in the rules of the British
Railways Superannuation Fund and
can be provided on request where
applicable.
through the Fund’s Management
Committee.
Q
A
Q So who decides whether my
A
condition meets the criteria of the rules?
The Trustee Company does this
through a Pensions Committee which
will consider all the information
available when making a decision. For
the British Railways Superannuation
Fund, the Trustee Company does this
Q
A
Can you explain what things the
Pensions Committee will consider
in making its decision?
To award an incapacity pension the
Pensions Committee must be satisfied
that you are incapacitated and that
is why you left your employment.
Also, it must be satisfied that your
incapacity is:
• more than a temporary condition;
• sufficient to prevent you from carrying out your duties; and
• sufficient to prevent you from carrying out any other duties that the Pensions Committee believes are suitable for you (such duties not being confined to railway duties).
The Pensions Committee will review
the medical evidence and reports from
the Medical Examiner and its Medical
Adviser to help make this decision.
Can anyone apply for incapacity
benefits?
To apply you must be under age
60**, have at least five years’ Scheme
membership in your current section and
have left employment with ill health.
If you have transferred benefits from
another scheme or another section
of the Railways Pension Scheme, the
membership, or transferred railway
pensionable service, for these benefits
also counts.
Q
A
Q
A
Q
A
How do I apply for incapacity
benefits?
You need an ‘Application for incapacity
benefits’ form (PM30) which both you
and your employer should complete.
There should be a form attached to
this leaflet or you can get one from
your employer or RPMI.
Will I have to have a medical
examination?
Yes. This will be done by your
employer’s Medical Examiner. Further
specialist advice may be sought which
can take considerable time in some
cases.
Will my application be accepted
automatically?
The Pensions Committee is responsible
for deciding if you meet the criteria set
out in the rules. Incapacity pension
PM30/version2/21.02.17
13 of 15
Your questions answered continued...
applications can only be accepted if
you meet those criteria. If they are not
met, the Pensions Committee will be
unable to approve your application.
you want to know what your benefits
might be we can give you an estimate.
Full details of your benefits will be
provided if your application is approved.
Q What happens if a decision can’t
Q
Is there an Annual Allowance
charge for incapacity retirement?
A
A
Not if you meet the government’s
current description of ill-health as
below. Possibly yes if you don’t.
RPMI will let you know if an Annual
Allowance charge applies to you.
be made immediately?
Q
A
The Pensions Committee may be
unable to make a decision based
on the medical report provided.
If this happens then we will pass
your application to the Pensions
Committee’s Medical Adviser and
write to you. It may take some
months before the Medical Adviser
is able to provide a report as he
or she may need to obtain further
reports from your own doctor or your
specialist, or refer you for a specialist’s
opinion. The Medical Adviser may
also need to examine you. When
the Medical Adviser replies, the
Pensions Committee will consider your
application again.
It sounds as if it could be a very
long time before I find out if my
application has been accepted. Will
anyone tell me about the progress?
If a decision on your application cannot
be made quickly we will write to you
about this. We will keep you advised
on the progress of your application
and you should contact us with any
queries. You should expect to hear
about the progress of your application
about one month after your employer’s
Medical Examiner sees you.
Q When a decision has been made,
how will I find out?
A
We will write to you soon after the
decision has been made.
Q If my application is accepted, is
there anything else I have to do?
A
You need to complete an ‘Application
for payment of benefits’ form to
receive payment of your benefits from
the date of leaving your employment.
Your employer will arrange this at the
appropriate time. We recommend
that this is done at the same time as
your incapacity application so that
payment of benefits is not delayed.
Q If my application is accepted, how
are my incapacity benefits worked
out?
A
Please refer to your Scheme booklet ‘A
guide for members’. This tells you how
incapacity benefits are worked out. If
Q
A
Q
If my application is turned down,
what benefits can I have?
A
You will be able to have the same
benefits as someone who has left
employment. If you are under age
50*, you can only have preserved
benefits. Once you are 50*, you
may apply for early payment of your
benefits, subject to the approval of
the Pensions Committee.
If you are aged 50* to 59 you may
be able to ask for your benefits to be
paid immediately (early retirement),
otherwise they will be preserved.
The government’s current description
of ill-health retirement is that ‘you are
not able to continue in your current
job and are not likely to be able to
take any other paid work to the
extent that is significant. For example,
you 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 work should
be insignificant; for example it should
be infrequent or only for a few days
during the year and payments must
be small in amount, not just as a
proportion of previous pay or salary.’
Q
If my application is approved,
when will my benefits be paid
and for how long?
If I do not agree with the
Committee’s decision, can I
appeal?
A
If you are not satisfied with the
Committee’s decision, you have the
right to appeal. The Railways Pension
Scheme has an established Internal
Disputes Resolution Procedure, in
accordance with the requirements of
the 1995 Pensions Act.
Your benefits will be paid when:
• your application has been
approved by the Pensions Committee; and
• we have received a correctly
completed ‘Application for payment of benefits’ form; and
• you have left employment.
In most cases, the decision will not be
made until you have left employment.
If this happens, your benefits will be
paid as soon as possible and the first
pension payment will include any
back payments (to the date you left
employment) which are owed to you.
The continuation of your incapacity
pension may be reviewed to ensure
that you still meet the conditions.
If the Pensions Committee has medical
evidence that you have recovered
sufficiently to be able to earn a living,
or are receiving earnings from
employment, it can decide to reduce
or suspend your incapacity pension.
If this happens, you will receive your
full incapacity pension again when you
reach age 60** and for the rest of
your life.
Your benefits will be reduced because
they are being paid early and can only
be paid if they are at least as much
as the minimum amounts required
by the Department for Work and
Pensions. From age 60**, normal
retirement benefits will be paid if you
have not taken them early.
We will send you details of the
benefits available if your application is
turned down.
This is a two-stage procedure.
Disputes are referred to the Head of
Pensions Operations, Rail Services, for
a decision at stage one, but if you are
not satisfied with the response, you
may ask for the disagreement to be
referred back to the Committee for its
determination.
You should write to the Head of
Pensions Operations, Rail Services,
setting out the reasons why you
are aggrieved. You will also need to
provide additional medical evidence or
reports upon which you wish to rely.
PM30/version2/21.02.17
14 of 15
Your questions answered continued...
Q
I will have no income, can I receive
any of my benefits now?
A
Yes, if you are over age 50*, you
can apply to receive early retirement
benefits while your incapacity
application is considered. If your
application is successful, your benefits
will be adjusted to take into account
the payments you have already
received. If your application is declined,
you will continue to receive early
retirement benefits.
Q
How do I apply for early
retirement benefits?
A
When RPMI is advised that you are
leaving due to ill health, you will be
sent a letter, an estimate of your
benefits based on early retirement and
an option form to return. If you have
not completed an ‘Application for
benefits’ form, your employer will be
asked to send one as we cannot pay
any benefits without it.
Q
How soon will I receive the
pension?
A
Your application for benefits will be
processed as soon as we receive a
completed ‘Application for benefits’
form and your option form.
All read as you need information is available on www.railwayspensions.co.uk or from the Helpline on
0800 2 343434
Disclaimer
The information provided in this leaflet is intended for general information and illustrative purposes. It does not constitute
investment or any other advice, and it is not intended to be a substitute for information and statements provided by RPMI. It
should not be relied on to make investment or other decisions. RPMI gives no warranty and accepts no responsibility for the
accuracy of any information provided, or for your reliance on that information. Your benefits will be worked out in accordance
with and subject to the governing trust deed and rules.
Although every effort has been made to ensure that the information given in this leaflet is accurate, none of the information
given can give you legal rights to benefits that differ from those provided in the pension trust and rules.
* Age 55 for some members (please check with RPMI if you do not know the earliest date from which you are eligible to apply for your benefits).
** A higher age than 60 for normal retirement benefit applies for some members (please check with RPMI if you do not know your Normal Pension Age).
PM30/version2/21.02.17
15 of 15