Ill-health retirement assessment
An independent occupational health assessment that gives a medical opinion on whether your health meets your pension scheme's criteria to retire early on ill-health grounds.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- It is an independent medical opinion on whether your health meets your pension scheme's specific ill-health retirement criteria, not a general judgement on how unwell you are.
- The pension scheme or trustees make the final decision; the doctor advises against the scheme's rules and the scheme can disagree with a recommendation.
- The outcome depends heavily on strong, up-to-date medical evidence about your diagnosis, treatment tried and likely future, so it can take weeks to gather.
- Read your scheme's criteria first, including any tiers, time limits and the meaning of 'permanent', because applying after your contract ends can change what you qualify for.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Gives an impartial, evidence-based medical opinion rather than relying on assumptions about your health.
Your condition is expected to improve with treatment or time, so 'permanent' incapacity is unlikely to be met yet.
You discuss your condition, treatment and how it affects your work. You can ask which criteria are being assessed and how the report will be used.
A clear written report and a clear scheme decision with reasons.
You discuss your condition, treatment and how it affects your work. You can ask which criteria are being assessed...
The doctor finalises the report once any outstanding GP or specialist reports arrive. If it is based on your own...
The report goes to the pension scheme or trustees with the doctor's opinion against the criteria.
The scheme makes the final decision, which may take further weeks. You are told the outcome and, ideally, the...
What is an ill-health retirement assessment?
An ill-health retirement assessment is an independent medical opinion on whether your health stops you doing your job, and whether that is likely to be permanent, measured against the specific rules of your pension scheme. It is usually carried out by an occupational health doctor who acts as an independent registered medical practitioner for the scheme.
The doctor does not decide whether you are 'ill enough' in a general sense. They give an opinion on whether the medical evidence meets the scheme's written criteria. The pension scheme or its trustees, not the doctor, make the final decision on your benefits.
Occupational health is impartial. The doctor is not 'on the employer's side' or 'on your side'. Their job is to weigh up the evidence fairly and explain it. They gather information from your GP, hospital specialists and any treatment you have had, alongside what you tell them.
Most schemes ask whether you are permanently unable to do your own job until your normal pension age. Some have a higher tier that also asks whether you are unable to do any other paid work. The wording matters, so it is worth reading your scheme's criteria before you start.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Ill-health retirement vs ordinary sickness absence support
| Aspect | Ill-health retirement assessment | Ongoing fitness/return-to-work advice |
|---|---|---|
| Main question | Permanently unable to work to pension age, against scheme rules | What helps you stay in or return to work now |
| Who decides | Pension scheme or trustees, advised by the doctor | Employer, advised by occupational health and you |
| Outcome | Pension benefits paid early, or not | Adjustments, phased return, redeployment |
| Reversible | Hard to undo once granted; tiers can be reviewed | Flexible and reviewed as your health changes |
Ill-health retirement is usually considered after reasonable adjustments and other options have been explored, not as a first step.
Preparing for your test
- Read your pension scheme's ill-health retirement criteria carefully, including any tiers, time limits and the exact meaning of 'permanent'.
- Gather your medical evidence: diagnoses, hospital letters, test results, and a record of treatments you have tried and how you responded.
- Make a list of all your medicines, doses and any specialists currently involved in your care.
- Think about how your condition affects your specific job tasks and your day-to-day activities, with examples.
- Note what treatment or rehabilitation is still planned, as 'permanent' usually means no realistic further improvement is expected.
- Check whether you need to apply while still employed, as eligibility can change once your contract ends.
- Bring or send consent for the doctor to request reports from your GP and specialists.
- Consider getting advice from your union, a pension adviser or your scheme administrator about the process and deadlines.
What happens
The doctor first gathers the medical picture. With your consent, they request information from your GP, hospital specialists and occupational health records, and review what treatment you have had and how it worked.
There is often an appointment, in person or by video or phone. The doctor takes a careful history of your condition, your treatment, your symptoms and how they affect your work and daily life. They may examine you. This is an assessment, not a treatment session, so they will not usually start new treatment.
The doctor then weighs the evidence against your scheme's written criteria and writes a report with their opinion, for example whether you meet the threshold and which tier may apply. Under the Access to Medical Reports Act, you can usually ask to see a report based on information from your own doctors before it is sent, and ask for factual errors to be corrected.
The report goes to the pension scheme or its trustees, who make the final decision. The doctor advises; they do not award the pension.
Is this test right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Your condition is expected to improve with treatment or time, so 'permanent' incapacity is unlikely to be met yet.
- Reasonable adjustments, a phased return or redeployment have not yet been properly tried, which schemes usually expect first.
- You have already reached, or are about to reach, your normal pension age, when ill-health retirement often no longer applies.
- Your real need is urgent medical care or crisis mental-health support, which should come first and separately.
Delay or rearrange if…
- Key treatment or specialist assessment is still ongoing and the outcome could change your prognosis.
- Important medical reports or test results are missing and would materially affect the opinion.
- You are in a mental-health crisis or your symptoms are unstable and you cannot engage fully with the assessment.
- You are unclear about scheme deadlines or whether to apply before leaving employment, and need advice first.
Alternatives to discuss
- Continuing in work with reasonable adjustments under the Equality Act.
- A phased return to work or temporary reduced duties while you recover.
- Redeployment to a different role that better fits your health.
- Ongoing treatment and rehabilitation before any decision about retirement.
- Other pension or benefit options, with independent financial or pension advice.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Gives an impartial, evidence-based medical opinion rather than relying on assumptions about your health.
- Pulls together your GP, specialist and treatment history into one clear assessment against the scheme's rules.
- Helps the pension scheme make a fair decision and can support early access to pension benefits if you qualify.
- Clarifies whether 'permanent' applies, or whether more treatment or time might change the picture.
- Can identify which tier of benefit may apply where a scheme has more than one level.
Risks & complications
- The opinion may be that you do not meet the scheme's strict criteria, even if you are genuinely unwell.
- Going over your diagnosis, prognosis and limitations can be emotionally difficult.
- The process can be slow while medical reports are gathered from several sources.
- Needing to provide more evidence, or attend a further assessment, before a decision is reached.
- The scheme disagreeing with the doctor's recommendation, or asking for a second opinion.
- A decision that you meet a lower tier when you hoped for a higher one.
- Confusion or distress if the difference between 'unfit now' and 'permanently unfit' was not clearly explained.
- An application becoming invalid because it was made after employment ended or after a scheme deadline.
- Personal medical information being shared more widely than necessary if consent and confidentiality are not handled properly.
The biggest risk is a mismatch between how unwell you feel and the scheme's strict legal test of 'permanent incapacity'. Ask the assessing doctor exactly which criteria they are applying, what 'permanent' means for your scheme, and what evidence would most help your case. Remember the doctor advises, but the scheme decides.
Published figures to discuss
There are no meaningful complication rates for this assessment because it is an opinion, not a procedure. Outcomes vary widely between schemes and individuals, depending on the exact criteria, the strength of the medical evidence and how 'permanent' is defined. National figures on approval rates are not reliable to quote here.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Permanent incapacity uncertainty | Common and scheme-specific | The opinion depends on prognosis, treatment response, role demands and the pension scheme rules. | Guide sourcesClinical context |
| Incomplete evidence | Common limitation | Specialist reports, occupational adjustments tried and functional evidence may be needed before a fair opinion. | RCN — Ill health retirement: NHS Pension Schemercn.org.ukSource-linked context |
| Conflict between clinical and pension questions | Recognised | Being unfit for current work is not automatically the same as meeting ill-health retirement criteria. | Guide sourcesClinical context |
| Expectation management | Clinically important | The assessor should explain independence and uncertainty, not advocate for employer or employee. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no physical recovery from this assessment. 'Afterwards' is about the report, the scheme's decision, and what happens next for your health and work.
- Waiting several weeks for all medical reports to be collected and the opinion to be written.
- Feeling drained or upset after discussing a long-term or worsening condition.
- Being asked for extra information or clarification before a decision.
- Uncertainty until the scheme, not the doctor, confirms the outcome.
Aftercare
- Keep a copy of any report you are shown, and check it for factual accuracy.
- Ask the scheme for the decision and the reasons in writing.
- If declined, ask what evidence or change would be needed for a reconsideration, and note any appeal deadlines.
- Continue any treatment and follow-up your own doctors recommend, regardless of the pension decision.
- Get independent advice from your union, a pension specialist or the scheme administrator if you are unsure.
- Look after your wellbeing; decisions about work and pensions can be stressful.
- Keep your employer and scheme informed of any change in your health or circumstances during the process.
- Scheme criteria and tier definitions read and understood
- Up-to-date GP and specialist letters gathered
- Full list of medicines and treatments tried
- Notes on how your condition affects specific job tasks
- Consent forms for medical reports completed
- Key deadlines noted (especially before employment ends)
- Source of independent advice identified (union, adviser, scheme)
⚠ Get urgent help if…
- Thoughts of harming yourself or that life is not worth living — get help now. If you are in immediate danger, call 999 or go to A&E anywhere in the UK. You can also call the Samaritans free, day or night, on 116 123. For urgent mental-health support, call 111 and choose the mental-health option in England, Scotland or Wales; in Northern Ireland, call Lifeline free on 0808 808 8000, or contact your GP or GP out-of-hours service.
- A serious worsening of your physical health while you wait — for urgent advice, contact your GP, or use NHS 111 in England, Scotland or Wales; in Northern Ireland, contact your GP out-of-hours service or your HSC Trust's Phone First service. In a life-threatening emergency, call 999 or go to A&E.
- Feeling unable to cope with the stress of the process — speak to your GP and any support available through work.
- A scheme deadline approaching that you may miss — contact the scheme administrator urgently.
- Being pressured to sign or agree to something you do not understand — pause and seek independent advice first.
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A clear outcome is an opinion that explains, in plain terms, whether your health meets the scheme's criteria and why, against the specific wording of the rules. A good report sets out your diagnosis, the treatment tried, the likely future, and how this maps onto the test of 'permanent incapacity'.
An opinion cannot guarantee the pension is awarded, because the scheme or trustees make the final decision. It also cannot predict your health with certainty; 'permanent' is a judgement about what is realistically expected, not an absolute promise.
Once granted, ill-health retirement is usually difficult to reverse, although some schemes can review a tier, especially if your health improves or you return to work. If your application is unsuccessful, the assessment reflects your health at that time; a future application with new evidence may reach a different outcome if your condition changes.
Related tests, treatments or support
An ill-health retirement assessment often follows earlier occupational health input, such as fitness-for-work advice, reasonable-adjustments advice and attempts at a phased return or redeployment. Schemes generally expect these options to have been considered before retirement on health grounds.
Follow-up & long-term care
Follow-up is mainly administrative: the scheme confirms its decision and, if granted, sorts out your benefits. If declined, you may pursue a reconsideration or appeal, usually with fresh medical evidence. Throughout, keep up your own clinical follow-up with your GP and specialists.
- Keep copies of all reports, decisions and correspondence in one place.
- Note any review dates the scheme sets for your tier or benefits.
- Tell the scheme if your health or circumstances change in a way that may affect your benefits.
- Continue treatment and follow-up recommended by your own doctors.
Repeat, follow-on and what comes next
- If declined, a reconsideration or appeal with stronger, up-to-date evidence is common and sometimes succeeds.
- Where a scheme has tiers, the tier awarded can sometimes be reviewed if your health changes.
- A fresh application later may reach a different outcome if your condition genuinely deteriorates.
- Once granted, ill-health retirement is usually difficult to reverse.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A clear written report and a clear scheme decision with reasons.
- A named contact at the scheme or occupational health service for questions.
- A defined reconsideration or appeal route with deadlines if the application is declined.
- Continued clinical follow-up with your own GP and specialists regardless of the outcome.
- Signposting to independent pension, union or financial advice.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Whether the assessment is paper-based or includes a face-to-face or remote appointment.
- How much medical evidence must be gathered from your GP and specialists, and any fees those doctors charge for reports.
- The complexity of your condition and how detailed the report needs to be against the scheme's criteria.
- Whether a single opinion is enough, or a second opinion, reconsideration or appeal is needed.
- Who is arranging and paying for the assessment, usually the employer or pension scheme rather than you.
- Who carries out the assessment and that they are an independent occupational health doctor.
- What the assessment includes: records review, appointment, examination and the written report.
- Any fees charged by your own GP or specialists for supplying reports, and who pays them.
- Whether you can see the report first and how to correct factual errors.
- What happens, and what it costs, if a reconsideration, appeal or second opinion is needed.
- Expected timescales for the report and for the scheme's decision.
On the NHS? The assessment is arranged through your employer or pension scheme as part of the retirement process, not bought privately like a treatment; the scheme, not the doctor, decides your benefits.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not being told the assessment is impartial and that the scheme, not the doctor, decides.
- Not understanding which criteria and which definition of 'permanent' are being applied.
- Not being offered the chance to see a report based on your own doctors' information before it is sent.
- Assuming all reasonable adjustments and alternatives have been explored when they have not.
- Not realising that applying after employment ends, or after a deadline, can change eligibility.
Marketing red flags
- Anyone promising to 'guarantee' ill-health retirement or a particular tier.
- Advice to resign or stop work before checking the scheme's timing rules.
- Suggestions to exaggerate symptoms or withhold information rather than rely on honest evidence.
- Pressure to pay for a fast-tracked decision the scheme has not agreed to.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- Exactly which scheme criteria are you assessing me against, and what does 'permanent' mean here?
- Which tier, if my scheme has tiers, do you think the evidence supports, and why?
- What medical evidence would most strengthen my case, and who should provide it?
- Can I see the report before it is sent, and how do I correct any factual errors?
- Have all reasonable adjustments and alternatives to retirement been properly considered?
- What are the deadlines, and could applying after my employment ends affect my eligibility?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my test, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this test not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Who decides whether I get ill-health retirement?
What does 'permanent' mean?
Will my employer see all my medical details?
Can I see the report before it is sent?
What if my application is turned down?
Do I have to stop work to apply?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: RCN — Ill health retirement: NHS Pension Scheme NHSBSA — Applying for ill health pension benefits Acas — Getting a doctor's report about a worker's health Faculty of Occupational Medicine Society of Occupational Medicine Access to Medical Reports Act 1988 (legislation) nidirect — urgent and emergency care services nidirect — GP out-of-hours service NHS England — NHS 111 crisis mental-health support NHS inform Scotland — urgent mental-health help NHS 111 Wales — mental health and wellbeing nidirect — mental health emergency and Lifeline (Northern Ireland)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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