Civil Service Injury Benefit Scheme · CAS-59296-Q2J5

CAS-59296-Q2J5

Ombudsman’s Determination Applicant: Mr I

Scheme: Civil Service Injury Benefit Scheme (CSIBS)

Respondents Cabinet Office (Scheme Manager)

MyCSP (Scheme Administrator)

Outcome

Complaint summary

Background information, including submissions from the parties Background

The sequence of events is not in dispute, so I have only set out the salient points. I acknowledge there were other exchanges of correspondence between the parties.

The relevant provisions are contained in the Civil Service Injury Benefits Scheme Rules (the Rules). Rule 1(ii) states:

“The benefits under this scheme will be paid at the discretion of the Minister and nothing in the scheme will extend or be construed to extend to give any person an absolute right to them.”

“Any question under this scheme shall be determined by the Minister, whose decision on it shall be final.”

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“the person or body appointed for the time being by the Minister to provide a consultation service on medical matters in relation to Civil Service pension and injury benefit arrangements …”

“ … benefits in accordance with the provisions of this part may be paid to any person to whom the part applies and

(i) who suffers an injury in the course of official duty, provided that such an injury is wholly or mainly attributable to the nature of the duty; or …

(ii) who contracts a disease to which he is exposed wholly or mainly by the nature of his duty …”

“Subject to the provisions of this part, any person to whom this part of this scheme applies whose earning capacity is impaired because of injury and:

(i) whose service ends before the pension age … may be paid an annual allowance and lump sum according to the [SMA’s] medical assessment of the impairment of his earning capacity, the length of his service, and his pensionable earnings when his service ends;

…

(iii) … who is receiving sick pay … for his injury, or whose entitlement to paid sick leave has expired and for whom the total amount of any sick pay …, together with any occupational pension … payable from public funds … and any of the national insurance benefits specified in rule 1.8(iii), amount to less that the amount of guaranteed minimum income provided for in rule 1.7 for total incapacity, may be paid a temporary allowance under this scheme of an amount sufficient to bring the said total up to the guaranteed minimum income for total incapacity …

(iv) who has not retired but because of his injury is employed in a lower grade or in a different capacity with loss of earnings, may be paid an annual allowance in accordance with the [SMA’s] medical assessment of the impairment of his earning capacity …”

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“However, please be advised that if the [SMA] is of the opinion that additional medical information is required to enable them to assess your application then it may impact on their ability to do this if they do not have consent to approach the relevant medical institute for this information.”

1 The email to MyCSP, dated 28 October 2020, was signed by a customer service administrator.

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“… the handling of the Claimant’s Temporary Injury Benefit by the Respondent; the Claimant’s subsequent grievance relating to the Temporary Injury Benefit; and occupational assessments carried out during his employment with the Respondent …”

Mr I’s position

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Cabinet Office’s position

Adjudicator’s Opinion

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Mr I’s further comments

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Ombudsman’s decision

“the … body appointed for the time being by the Minister to provide a consultation service on medical matters in relation to … injury benefit arrangements”

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I do not uphold Mr I’s complaint.

Anthony Arter Pensions Ombudsman

16 August 2022

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