Ill Health Retirement Application Form - Pensions

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GUS9 ISLE OF MAN GOVERNMENT UNIFIED SCHEMEDEFERRED ILL HEALTH RETIREMENT APPLICATION FORMD7. These questions relate to functional abilities and must be completed by the occupationalhealth doctor. GPs and clinical specialists may comment if they feel able to do so.D7.1 How does this member’s diagnosed medical condition(s) impact on their capacity to carryout gainful employment?D7.2 With normal therapeutic intervention please comment on the likelihood of improvement infunctional abilities before the normal benefit age 65.D7.3 Please summarise information you consider to be relevant to this member’s long termincapacity for employment giving particular consideration to the eligibility criteria for Upper Tierill-health benefits as described on page 4 of this form.Please attach copies of any consultant medical specialist reports or case notes which ou have inrelation to the member’s present medical confition which might be useful in processing thisapplication. Access to this information may prevent delays in reaching a decision on thisperson’s application.14
GUS9 ISLE OF MAN GOVERNMENT UNIFIED SCHEMEDEFERRED ILL HEALTH RETIREMENT APPLICATION FORMD8. Terminal illnessDoes this member have a medical condition that has a serious impacton life expectancy?YesNoIf ‘Yes’ and information is available from the relevant specialist,please include a copy of their report / correspondence.Is the member aware of the diagnosis? Yes NoIs the member aware of the prognosis? Yes NoPlease list the papers enclosed with this application:15
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Ill Health Retirement Application Form - Pensions

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