LGPS ill-health form wrong? How to fix it and challenge your tier

You should not have to fight your employer’s paperwork while you are too ill to work. If your LGPS ill-health referral misstates your job or leaves out medical evidence, ask for the full file and challenge the errors in writing. Do not let a promise to “sort the form out” use up your appeal time.

This guide covers the LGPS in England and Wales and the law in force on 1 October 2026. Scotland and Northern Ireland have separate rules. The tribunal deadline change on that date is already in force, not a future reform.

Who actually decides your tier

Not the doctor. Not the pension fund. Your scheme employer decides whether you get ill-health retirement and which tier you get, under regulation 36 of the Local Government Pension Scheme Regulations 2013. It must get a certificate first from an independent registered medical practitioner, known as the IRMP. Then it decides.

The certificate must address the two tests in regulation 35. First, are you permanently incapable of doing your own job efficiently because of ill health? Second, are you not immediately capable of any gainful employment? The doctor also assesses when you are likely to become capable of gainful employment. The employer uses that evidence to decide the tier.

A referral that omits your restrictions or describes a lighter job can leave the doctor answering the wrong question. That gives you a reason to challenge the decision. It does not prove that a higher tier is due.

The referral must describe the work you actually do

Ask whether the pack includes your actual duties, relevant occupational health reports, GP and consultant evidence, sickness history and adjustments tried. For a school cleaner, “general cleaning” says little about pushing heavy machines, lifting buckets or working with chemicals. Point out those duties and provide evidence of the restrictions that prevent you doing them.

The IRMP must not previously have advised on or been involved in your case. A different doctor from the same occupational health provider is allowed, so the firm’s name alone does not show a lack of independence. Where the employer is not the administering authority, that authority must approve the choice of IRMP. The employer and doctor must have regard to the relevant government guidance.

Get the papers and request corrections today

Under regulation 72 the employer must decide as soon as reasonably practicable. Regulation 73 requires written notification with challenge rights. Ask for the evidence behind the decision too; the decision letter alone will not tell you what the doctor saw.

1. Ask for the full pack. Email HR or the employer’s pensions contact for the completed referral, every attachment sent to the IRMP, the certificate, occupational health reports and the written decision. Ask for the stage 1 adjudicator’s contact details. Keep a copy of your request.
2. Number the errors and attach proof. Set out what the referral says, what is wrong and the document that supports the correction. Include illness-related cuts to hours or pay, missing restrictions and adjustments wrongly recorded as having happened.
3. Request reconsideration. Ask the employer to correct factual errors, put the complete evidence before the IRMP and issue a fresh, reasoned decision. If it refuses, ask why. If you dispute the medical prognosis, provide medical evidence that addresses it.
4. Protect the appeal deadline. If a decision has been made, do not wait for an informal correction request to finish before submitting a stage 1 pension dispute. Say which decision you challenge, what evidence is missing and what you want reconsidered.
5. Bring in your union and the fund. Ask your UNISON, GMB or Unite branch, or whichever union represents you, for a rep and access to pension advice. If the employer will not decide, ask the administering authority to intervene. It has its own appeal powers over certain employer decisions and failures under regulation 79; this is separate from your appeal.

The three tiers and why the wording matters

For an active-member award, you must satisfy the two-year qualifying-service requirement, leave before normal pension age and have your employment terminated by the employer on ill-health grounds. Qualifying service is not always simply two years in your current job; transferred benefits and other provisions in regulation 3 can matter. Normal pension age for post-2014 benefits is linked to State Pension age, with a minimum of 65.

Gainful employment means paid employment for at least 30 hours each week for at least 12 months. Being unable to return to cleaning or care work does not by itself establish that you cannot do any such employment. Ask your clinician to address your functional limits, likely recovery and ability to sustain work, not only your diagnosis.

An occupational health report about fitness or adjustments is not necessarily the statutory IRMP certificate. Check that the employer obtained the certificate the pension rules require.

Two disputes, two clocks: do not mix them up

The pension dispute asks whether you qualify and which tier applies. An employment claim asks whether the dismissal or your treatment at work was unlawful. A capability dismissal does not automatically establish pension entitlement, and a pension award does not make the dismissal fair. Our guide to dismissal because you are ill covers that side.

Acas explains the October deadline change. Notify it within the applicable tribunal limit. Timely early conciliation pauses that clock; a pension appeal, grievance or dismissal appeal does not. The starting date depends on the claim, usually the effective termination date for unfair dismissal and the discriminatory act for discrimination. Get advice where events straddle 1 October or form a continuing complaint.

The appeal ladder: dispute, then Ombudsman

The Internal Dispute Resolution Procedure, usually called IDRP, is the scheme’s formal challenge route. Start it within time even if you are still asking for documents. You do not need a lawyer, and a union representative can help you identify the decision, evidence and remedy.

1. Stage 1 goes to the appointed adjudicator. Under regulation 74, apply in writing to the adjudicator appointed by the body whose decision, act or omission you challenge, usually the employer. The usual limit is six months from notification of the decision, or the act or omission. An extension is possible, not guaranteed. Do not assume continued silence restarts the period.
2. Set out the decision you want reconsidered. Include your identifying details, the decision letter if available, numbered grounds and supporting documents. Ask for a decision based on the correct duties and full medical evidence, and reconsideration of the appropriate tier. A correction request alone is not a substitute for a formal IDRP application.
3. Expect a decision or an interim reply. Regulation 75 requires a reply within two months of the application. If the adjudicator cannot decide then, it must explain the delay and give an expected decision date. An adjudication generally takes effect as the original body’s decision; a discretionary matter goes back for reconsideration.
4. Stage 2 goes to the administering authority. Under regulation 76, refer the case within six months of receiving the stage 1 decision. Where only an interim reply arrives, the limit is seven months from the expected decision date. With neither a decision nor an interim reply, it is nine months from the stage 1 application. These are outer limits, not instructions to wait. Nobody involved in the original or stage 1 decision may decide stage 2.
5. Take an unresolved complaint to the Pensions Ombudsman. It can examine missing evidence, procedural errors and delay. Normally use the scheme’s dispute process first, and ask the Ombudsman about its own time limit rather than assuming IDRP preserves it indefinitely. A procedural failure can lead to a direction to reconsider the decision, but does not itself prove entitlement to Tier 1.

Keep the application, attachments, proof of delivery and each reply together. Ask your fund for its IDRP guide. MoneyHelper can explain pension complaint options; Citizens Advice or a law centre may help with the employment dispute.

Contractor staff: check you are in the scheme at all

Cleaning or catering in a council building does not, on its own, make you an LGPS member. If a private contractor employs you, check whether it participates through an admission agreement and whether that agreement covers your employment. Coverage may be by a class of employees, not a list naming each person. Do not assume a new recruit has the same pension terms as someone transferred from the council.

Ask the fund to confirm your membership, the relevant employer and the agreement’s coverage in writing. Agency employment and genuine self-employment do not give you LGPS rights just because the work takes place at a school or council site. If promised membership is missing, get union advice on the admission agreement, transfer documents and contract. Do not accept “TUPE does not cover pensions” as a complete answer. The workplace pensions guide explains the separate employer duties.

One protection for outsourced staff who are members: if the contractor stops being a scheme employer, the administering authority steps into its shoes for Tier 3 reviews under regulation 37. You do not lose review rights because the firm lost the contract.

Money while you wait: sick pay, notice, redundancy

A pending pension dispute does not create extra sick pay or guarantee full notice pay. Ask payroll for a written breakdown of occupational sick pay, Statutory Sick Pay, notice and any final wages. Check your contract and get advice before agreeing a termination date or resigning, because the active-member pension route requires employer termination on ill-health grounds.

Since 6 April 2026, Statutory Sick Pay has been payable from the first qualifying day, without the old lower earnings limit. Subject to eligibility, the weekly rate is £123.25 or 80% of average weekly earnings, whichever is lower, for up to 28 weeks. See sick pay rules. An ill-health capability dismissal is not automatically a redundancy, so do not budget for statutory redundancy pay merely because the job is ending.

If illness caused your hours or pay to fall before leaving, flag that in the medical referral. The IRMP certificate must address the reduction. Under regulation 39, the relevant illness-related reduction is disregarded when calculating the assumed pensionable pay used for the addition. Part-time membership is not a reason to leave this question blank.

Tier 3 reviews, stopped pay and deferred members

Under regulation 37, the employer must review Tier 3 after 18 months in payment, obtaining a further IRMP certificate. It can continue payment within the normal three-year maximum, award Tier 2 from the review decision, or stop payment. If you reach normal pension age while receiving Tier 3, your retirement pension continues and the special Tier 3 rules cease to apply.

Tell the former employer when you start any employment, not only work you consider gainful, and answer reasonable enquiries about hours and pay. Tier 3 stops if it decides the job is gainful employment or you fail to answer those enquiries. It can treat work as likely to last at least 12 months without waiting for 12 months to pass, and can recover payments for periods of gainful employment.

You can request a Tier 2 review while receiving Tier 3. Regulation 37 also permits an award within three years after Tier 3 payments stop, supported by a further certificate and the required medical findings. An award under that provision starts from the determination date. Do not leave your request until the end of that window. The reviewing IRMP may be the same doctor as before.

If payment was stopped wrongly, challenge the stopping decision through IDRP. A valid discontinuance under regulation 37 does not permit a fresh Tier 3 award, but that is different from correcting an unlawful decision to stop an existing award.

If you already left with deferred benefits and are not receiving a pension, regulation 38 provides a separate ill-health route. The tests concern permanent incapacity for the old job and inability to undertake gainful employment before normal pension age or for at least three years, whichever is sooner. Apply in writing to your former employer, or the administering authority if it is no longer a scheme employer. The usual award is your accrued pension without early-payment reduction, not a future-service addition. Older membership can bring different rules, so ask the fund which provisions apply.

Before any of this reaches the form stage, the employer should have considered adjustments. See reasonable adjustments for disabled workers.

Scotland and Northern Ireland use different rules

Do not use the England and Wales tier table or regulation numbers for another jurisdiction. Scotland has its own scheme legislation and an SPPA ill-health retirement guide. Ask your Scottish pension fund for the applicable tests and dispute route.

Northern Ireland is materially different. NILGOSC’s guidance describes two tiers, not three, and NILGOSC makes the pension decision on its independent doctor’s report. It requires at least two years’ scheme membership. For employment claims there, contact the Labour Relations Agency, not Acas. Do not apply the Great Britain October tribunal deadline change without checking Northern Ireland’s rules.