PART 12 N.I.Determination of Questions of Appeals

Modifications etc. (not altering text)

CHAPTER 1N.I.

Determinations by the scheme managerN.I.

F1160.  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Textual Amendments

[F2Determinations and decisions of the Scheme ManagerN.I.

161.—(1) The question whether a person is entitled to any and if so what awards shall be determined in the first instance by the Scheme Manager.]

(2) Subject to paragraph (3), before deciding, for the purpose of determining that question or any other question arising under this Scheme—

(a)whether a person has been disabled;

(b)whether any disablement is likely to be permanent;

(c)whether the person would be able to undertake regular employment;

(d)whether a person is capable of performing the duties of a regular firefighter; or

(e)any other issue wholly or partly of a medical nature,

the [F3Scheme Manager] shall obtain the written opinion of an independent qualified medical practitioner selected by it and the opinion of that practitioner shall be binding on it.

(3) If by reason of the person's refusal or wilful or negligent failure to submit to medical examination by the practitioner selected by it the [F3Scheme Manager] is unable to obtain the opinion mentioned in paragraph (2), it may—

(a)on such other medical evidence as it thinks fit; or

(b)without medical evidence,

give such decision on the issue as it may choose to give.

Textual Amendments

Appeal against opinion on a medical issueN.I.

162.—(1) Where—

(a)an opinion of the kind mentioned in regulation 161(2) has been obtained; and

(b)within 14 days of his being notified of the Pension Board's decision on the issue the person concerned applies to it for a copy of the opinion,

the [F4Scheme Manager] shall supply him with a copy, together with a statement informing the person concerned that, if he wishes to appeal against the opinion, he must give the [F4Scheme Manager] written notice of his grounds of appeal, together with his name and address, within 14 days beginning with the date on which he is so supplied.

(2) If the person concerned is dissatisfied with the opinion which has been supplied to him under paragraph (1), he may appeal against it by giving notice to the [F4Scheme Manager] in accordance with regulation 164(1) and (2).

(3) The [F4Scheme Manager] shall be bound by any decision on a medical issue duly given on an appeal under this regulation. A decision given under this regulation overrules that of the qualified medical practitioner selected by the [F4Scheme Manager ]under regulation 161.

(4) In this regulation, “medical issue” means any issue referred to in regulation 161(2).

(5) Further provisions as to appeals under this regulation are contained in regulation 164.

Textual Amendments

Appeals against decision of the Pension BoardN.I.

F5163.  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Textual Amendments

CHAPTER 2N.I.Appeal to Independent Medical Referee

164.—(1) Subject to paragraph (2) written notice of appeal against an opinion of the kind mentioned in regulation 162(2) stating—

(i)the grounds of the appeal; and

(ii)the appellant's name and his address,

must be given to the [F6Scheme Manager] within 14 days beginning with the date on which he is supplied by it with a copy of the opinion.

(2) Where—

(a)notice of appeal is not given within the period specified in paragraph (1); but

(b)the [F6Scheme Manager] is of the opinion that the person's failure to give it within that period was not due to his own default,

it may extend the period for giving notice to such length, not exceeding 6 months from the date mentioned in paragraph (1), as it thinks fit.

(3) On receiving a notice of appeal the [F6Scheme Manager] shall supply the Department with two copies of the notice and two copies of the opinion.

(4) The Department shall refer an appeal to an independent medical referee appointed by it and shall supply him with a copy of the notice and a copy of the opinion.

(5) The independent medical referee shall secure that the appellant and the [F6Scheme Manager] (“the Parties”) have been informed—

(a)that the appeal is to be determined by him; and

(b)of an address to which communications relating to the appeal may be delivered.

(6) Subject to paragraph (9), the independent medical referee—

(a)shall interview and medically examine the appellant at least once; and

(b)may interview or medically examine him or cause him to be interviewed or medically examined on such further occasions as the independent medical referee thinks necessary for the purpose of deciding the appeal.

(7) The independent medical referee shall—

(a)appoint, and

(b)give the appellant and the [F6Scheme Manager] not less than 21 days' notice of,

the time and place for every interview and medical examination; if the independent medical referee is satisfied that the appellant is unable to travel, the place shall be the appellant's place of residence.

(8) The appellant shall attend at the time and place appointed for any interview or medical examination by the independent medical referee.

(9) If—

(a)the appellant fails to comply with paragraph (8); and

(b)the independent medical referee is not satisfied that there was reasonable cause for the failure,

the independent medical referee may dispense with the interview or medical examination required by sub-paragraph (6)(a) or, as the case may be, with any further interview or medical examination required by sub-paragraph (6)(b), and may decide the appeal on such information as is then available.

(10) Any interview under paragraphs (6) to (10) may be attended by persons appointed for the purpose by the [F6Scheme Manager] or by the appellant or by each of them.

(11) Where either party to the appeal intends to submit written evidence or a written statement at an interview held [F7under paragraphs (6) to (10)] , the party shall, subject to paragraph (12), submit it to the independent medical referee and to the other party not less than 7 days before the date appointed for the interview.

(12) Where any written evidence or statement has been submitted under paragraph (11) less than 7 days before the date appointed for the interview, any written evidence or statement in response may be submitted by the other party to the independent medical referee and the party submitting the first-mentioned evidence or statement at any time up to, and including, that date.

(13) Where any written evidence or statement is submitted in contravention of paragraph (11), the independent medical referee may postpone the date appointed for the interview and require the party who submitted the evidence or statement to pay such reasonable costs of the independent medical referee and of the other party as arise from the postponement.

(14) The independent medical referee shall supply the Department with a written report of his decision on the relevant medical issues and the Department shall supply a copy of the report to the appellant and to the [F6Scheme Manager] .

(15) There shall be paid to the independent medical referee—

(a)such fees as are determined in accordance with arrangements made by the Department; or

(b)where no such arrangement have been made, such fees and allowances as the Department may from time to time determine

(16) Any fees and allowances payable to the independent medical referee under paragraph (15) shall—

(i)be paid by the [F6Scheme Manager] ; and

(ii)be treated for the purposes of paragraph (17) as part of the Pension Board's expenses.

(17) Subject to paragraph (13) and paragraphs (18) to (22), the expenses of each party to the appeal shall be borne by that party.

(18) Where the independent medical referee—

(a)decides in favour of the [F6Scheme Manager] ; and

(b)reports that in his opinion the appeal was frivolous, vexatious or manifestly ill-founded,

the [F6Scheme Manager] may require the appellant to pay them such sum, not exceeding the amount of the fees and allowances payable to the independent medical referee under paragraph (15), as it thinks fit.

(19) Where the appellant gives notice to the independent medical referee of withdrawing the appeal within 21 days beginning with the date appointed for an interview by the independent medical referee under paragraph (7), the [F6Scheme Manager] may require the appellant to pay it such sum, not exceeding the total amount of fees and allowances payable to the independent medical referee under paragraph (15) as it thinks fit.

(20) Where the independent medical referee—

(a)decides in favour of the appellant, and

(b)does not otherwise direct,

the [F6Scheme Manager] shall refund to the appellant the amount specified in paragraph (21).

(21) The amount is the total of—

(a)any personal expenses actually and reasonably incurred by the appellant in respect of any interview [F8under paragraphs (6) to (10)] ; and

(b)if any such interview was attended by a qualified medical practitioner appointed by the appellant, any fees and expenses reasonably paid by the appellant in respect of such attendance.

(22) For the purpose of paragraphs (18) and (20) any question arising as to whether the independent medical referee's decision is in favour of the [F6Scheme Manager] or of the appellant shall be decided by the independent medical referee, or in default by the Department.

(23) Any notice, information or document which an appellant is entitled to receive for the purposes of this regulation shall be deemed to have been received by him if it was duly posted in a letter addressed to him at his last known place of residence.

Textual Amendments

CHAPTER 3N.I.Dispute Resolution

[F9Appeals on other issuesN.I.

165.  Where a person makes a formal complaint to the Scheme Manager which does not involve an issue of a medical nature, the Scheme Manager shall deal with the complaint under the arrangements implemented by it pursuant to the requirements of article 50 of the Pensions (Northern Ireland) Order 1995 (requirement for dispute resolution arrangements) and the Occupational Pension Schemes (Internal dispute Resolution Procedures) (Consequential and Miscellaneous Amendments) Regulations (Northern Ireland) 2008.]

Textual Amendments