NHS Permanent Injury Benefit

I’ve a client who’s been turned down for NHS PIB on the grounds the condition would have occurred without the accidents. The letter was penned by a case manager without any apparent medical input.  Has anyone fought one of these cases before. I did 5 cases over 20 years ago for 5 nurses, my wife’s a nurse.
At first glance, my opinion is my client needs a specialists report. Any guidance would be appreciated. Terry

Ah yes. That wonderful totally self-administered scheme without any contradictions at all in the fact it’s entirely self-administered until you can get a case to the Pensions Ombudsman. Lucky you for finding a person who isn’t excluded by virtue of being employed by a private company paid to provide services to the NHS!

I think this is organised so they can make a decision without medical input based on the existing documentation such as accident records etc. They can refer to their own Occupational Health if needs be but it’s by no means automatic so it’s not that unusual for a case manager to make a decision on the balance of probabilities without medical input. As can be seen elsewhere on here I am no advocate for reliance upon medical evidence but this is absolutely one of those instances where, yes, you need an independent medical report. Witness statements from colleagues can also assist tremendously but good luck persuading anyone to speak up in support. My last case of this type was about 5 years ago and the staff member concerned referred me to their best friend at work as someone who witnessed said accident and knew their functional ability before and after as they shared office space and shifts for 15 years together. I sat down with the best friend who told me that for her to pen a statement, however brief, would be career suicide. Brilliantly, the client produced the office cleaner as a witness. Employed by a private company temporarily. Nothing to lose. Fantastic witness statement. Probably more damning than the corroborating medical evidence describing the injury as “could not possibly have been caused outside of working in the room in question”.

I am intrigued by the idea a condition would have occurred without the accidents. That isn’t, as far as I can see, a ground for exclusion under the T&Cs; of the scheme. Pre-existing conditions obviously but that wording seems either odd or careless.

Thanks for this Mike