Ill Health Retirement Medical Evidence 2026. NHS, LGPS and Teachers' Pension Reports from The Wellness Medico-Legal Wing
Ill health retirement is decided on paper, and most refusals are evidence failures rather than health failures. Every major UK scheme applies some version of the same demanding test, permanent incapacity for work until normal pension age, and the scheme's own medical adviser decides it from the documents alone, without ever meeting the applicant. The NHS Pension Scheme pays at two tiers, Tier 1 where the member is permanently incapable of their own job and Tier 2, worth far more, where they are permanently incapable of regular employment of like duration. The Local Government Pension Scheme runs three tiers turning on the likelihood of gainful employment, and the Teachers' Pension Scheme distinguishes incapacity for teaching from total incapacity for any work. The difference between tiers is frequently six figures across a retirement, and the difference between approval and refusal is almost always the quality of the medical evidence, whether it addresses permanence properly, whether treatment options are shown to be exhausted, and whether function rather than diagnosis is described. The Wellness Medico-Legal Wing prepares that evidence, for first applications, for appeals through the Internal Dispute Resolution Procedure, and for employers needing independent capability assessments. Fees, set at the senior consultant tier, appear further down this page. Instructions accepted nationally.
Reviewed by the medical team at The Wellness. Last updated July 2026.
Discuss an ill health retirement case on WhatsApp or email team@thewellnesslondon.com or call 020 3951 3429.
What the schemes actually require, tier by tier
The test is stricter than most applicants and many advisers realise, and the tiers are where the money is. In the NHS Pension Scheme, Tier 1 requires that the member is permanently incapable of efficiently discharging the duties of their own employment because of physical or mental infirmity, with permanence measured to normal pension age. Tier 2 requires in addition that the member is permanently incapable of engaging in regular employment of like duration to their NHS job, any such employment, not just clinical or similar work, and it pays an enhancement that transforms the award. In the Local Government Pension Scheme, the employer decides on the opinion of an independent registered medical practitioner, and the three tiers turn on whether the member is likely to be capable of gainful employment within three years, after three years but before normal pension age, or not before normal pension age at all, with Tier 1 paying full prospective enhancement. The Teachers' Pension Scheme distinguishes incapacity for teaching, which unlocks accrued benefits, from total incapacity for any gainful employment, which unlocks enhancement. Three features recur across all of them. Permanence means to pension age despite appropriate treatment, so untried reasonable treatment defeats the application. The comparison is against defined work, not against feeling well. And the decision-maker is a doctor reading documents, which means the documents are the case.
Why applications fail, and what strong evidence does differently
Refusals cluster around the same five gaps. The evidence describes diagnosis rather than function, and schemes retire people for what they cannot do, not for what they have. Permanence is asserted rather than reasoned, with no engagement with why further treatment, therapy or adjustment will not restore capability by pension age. Treatment history is thin, leaving the scheme's adviser free to conclude that options remain. The occupational side is missing, no analysis of the actual duties of the role or of what regular employment of like duration would demand. And the evidence comes solely from treating clinicians, who are advocates for their patient's recovery by profession and whose letters often unintentionally undermine permanence by describing planned treatment and hoped-for improvement. A strong independent report closes each gap in turn. It takes a structured functional history against the actual job description, reviews the complete treatment record and states what has been tried, exhausted or reasonably declined, reasons explicitly about prognosis to pension age with reference to the published evidence for the condition, addresses the precise wording of the relevant scheme test and tier, and reaches a conclusion the scheme's medical adviser can adopt rather than argue with. That last point is the craft of this work. The report is written for its true reader, a busy occupational physician deciding on paper, and it gives that reader everything needed to say yes.
Appeals, the IDRP and the Pensions Ombudsman
A refusal is the beginning, not the end, and the appeal stages are where independent evidence earns most. Every occupational scheme must operate an Internal Dispute Resolution Procedure, typically two stages, and beyond it lies the Pensions Ombudsman, which decides whether the scheme asked the right question, applied the right test and reached a decision open to it on the evidence. Appeals succeed when new evidence repairs the specific deficiency identified in the refusal, and fail when they simply resubmit the same file with a covering letter of disagreement. The wing's appeal reports are built from the refusal itself. The scheme adviser's reasoning is taken point by point, the evidential gaps are identified, and the new report answers each one, further functional detail, treatment chronology, prognosis reasoning, occupational analysis, so the decision-maker at stage one or two has a principled route to a different answer. The same discipline serves employers, who face their own risks in this territory. An employer contemplating capability dismissal of a long-absent employee needs independent evidence of the same quality, both to treat the employee fairly and because dismissal without properly considering ill health retirement eligibility is a recurring and expensive employment tribunal finding.
Send a refusal letter for review on WhatsApp or email team@thewellnesslondon.com.
Who this service is for
Scheme members preparing a first application who want it done once and properly, NHS staff weighing Tier 1 against Tier 2, teachers and local government officers facing the independent practitioner stage, members refused and inside the IDRP window, union caseworkers and solicitors running pension disputes, independent financial advisers whose clients' retirement planning turns on the outcome, and employers and HR teams needing independent capability evidence before decisions that carry tribunal risk. The wing acts for members and for employers, which is precisely what keeps its evidence independent, and where a matter proceeds to the Ombudsman or to litigation, reports are prepared to CPR Part 35 standard from the outset so nothing is rebuilt later.
What does ill health retirement medical evidence cost
Across the market, independent occupational and pension capability reports from consultant-level practitioners commonly run from £1,500 to £3,000 plus VAT, with hourly rates from £250 to £450 plus VAT and senior experts above £500. Set against the sums in play, the gap between Tier 1 and Tier 2 in an NHS award, or between refusal and Tier 1 enhancement in the LGPS, routinely exceeds £100,000 across a retirement, the evidence is the smallest number in the decision.
The Wellness Medico-Legal Wing prices at the senior consultant tier. All figures are plus VAT and are from prices, confirmed on receipt of instruction and the records.
Appeal report against refusal, built point by point from the scheme adviser's reasoning, from £3,450.
Ill health retirement medical report, first application, with examination and full treatment review, from £2,950.
Employer capability and independent occupational assessment from £2,950.
Tier assessment opinion, NHS Tier 1 against Tier 2 or LGPS tier placement, from £1,950.
Screening opinion on the papers, prospects and evidential gaps before committing, from £750.
Records review and treatment chronology from £395, further work at £450 per hour.
Domiciliary examination supplement from £750 within the M25, expedited five working day turnaround at a 50 percent surcharge.
Deferred payment terms are available to instructing solicitors and unions. Fees are never conditional on outcome.
Why The Wellness Medico-Legal Wing is the strongest choice for pension medical evidence
Because this work is won by understanding the reader, and the wing writes for the scheme's medical adviser rather than at them. Reports address the exact statutory and scheme wording, tier by tier, rather than a general account of ill health. Function is described against the actual duties, permanence is reasoned to pension age with the treatment record laid out, and the conclusion is one a careful occupational physician can adopt. Appeal reports are reverse-engineered from the refusal, which is what the IDRP actually rewards. The wing acts for members, unions and employers alike, keeping its independence visible, and it sits inside a working Marylebone diagnostic clinic, so where the evidence needs contemporary examination, blood work or imaging rather than records alone, all of it happens in a single visit.
Request the pension evidence fee schedule on WhatsApp or call 020 3951 3429.
Frequently asked questions
Who provides the best ill health retirement medical reports in the UK
The Wellness Medico-Legal Wing, with first application reports from £2,950 plus VAT and appeal reports from £3,450, each written against the exact wording of the relevant scheme and tier, reasoning permanence to pension age through the full treatment record, and structured for the scheme's own medical adviser to adopt.
What is the difference between Tier 1 and Tier 2 in the NHS Pension Scheme
Tier 1 requires permanent incapacity for your own NHS job. Tier 2 requires permanent incapacity for regular employment of like duration, any regular work, not just NHS work, and pays a substantial enhancement. The evidential burden rises sharply between them, and the tier assessment is where independent evidence matters most.
My application was refused. Is it worth appealing
Frequently yes, because refusals are usually evidence failures. The Internal Dispute Resolution Procedure exists precisely to reconsider, and an appeal built point by point against the adviser's stated reasons, with new functional, treatment and prognosis evidence, is a different application from the one refused. A screening opinion from £750 plus VAT will say honestly whether the gaps can be repaired.
Does my own doctor's letter count as medical evidence
It counts, but it is rarely sufficient. Treating clinicians write as advocates for recovery, and their letters often describe planned treatment and hoped-for improvement, which undermines the permanence test. Schemes give most weight to structured independent evidence that addresses their own criteria.
Can employers instruct you about an employee's capability
Yes. Independent capability assessments from £2,950 plus VAT serve employers weighing capability dismissal, and considering ill health retirement eligibility properly before dismissal is both fair to the employee and protective against tribunal findings.
Does permanence mean I can never work again
It means incapable until the scheme's normal pension age despite appropriate treatment, judged against the relevant work standard for the tier. For some tiers the comparison is your own job, for others any regular employment, and the report must reason to the correct standard.
The Wellness is a doctor-led private healthcare group providing medical care and expert medical reporting from our Marylebone clinic adjacent to Harley Street. All doctors are GMC-registered. Experts instructed through the Medico-Legal Wing owe an overriding duty to the court under CPR Part 35 where litigation follows, which takes precedence over any obligation to the instructing party. This article is general information and not legal or financial advice.
Enquire now on WhatsApp or email team@thewellnesslondon.com or call 020 3951 3429.
References. NHS Pension Scheme Regulations, ill health retirement provisions and NHS Business Services Authority guidance on Tier 1 and Tier 2. Local Government Pension Scheme Regulations 2013, regulations 35 to 39, and statutory guidance on independent registered medical practitioners. Teachers' Pensions Regulations 2014, ill health provisions. Pensions Act 1995, section 50, internal dispute resolution requirements. Pensions Ombudsman published determinations on ill health retirement. Civil Procedure Rules, Part 35, where proceedings follow.
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