Critical Illness

Critical Illness Information

An employee who becomes incapacitated as a result of a critical illness or serious physical injury may upon application be granted extended paid sick leave in exceptional circumstances as provided for in the Labour Court recommendation (LCR 20667) in relation to critical illness.

The process is outlined below:

• The employee must apply to his/her employer in writing for access to the critical illness provisions.
• Upon receipt of the critical illness application, the employer must initiate a referral to the OHS by logging onto www.medmark4teachersna.ie and completing the appropriate critical illness referral form. Upon completion of this referral, the employer will receive a unique critical illness Referral Number which will be required in the case of employers entering absences on the OLCS.
• A copy of the referral must be made available to the employee.
• The employee must furnish to the OHS a Doctor to Doctor report from his/her treating consultant. The unique critical illness referral number must be furnished with this Doctor to Doctor report. The treating consultant’s specialism must be appropriate to the critical illness for which the employee is making a claim. It is essential that the medical evidence submitted is comprehensive and includes all relevant clinical details. It must address diagnosis, treatment and prognosis. The cost of compilation of all such reports is the responsibility of the employee.
• Upon receipt of the critical illness referral and the appropriate Doctor to Doctor report/s, the OHS will advise the employer by way of a report if, in their opinion, the following criteria are met:
  • The employee is medically unfit to return to his or her current duties or (where practicable) modified duties
  • The nature of this medical conditions has at least one of the following characteristics:
    • Acute life threatening physical illness
    • Chronic progressive illness, with well-established potential to reduce life expectancy ¹
    • Major physical trauma ordinarily requiring corrective acute operative surgical treatment
    • In-patient hospital care of ten consecutive days or greater²
• Where the OHS advises that the criteria are met, employers will be provided with a unique critical illness Recommendation Number. This number will also be required in the case of employers entering absences on the OLCS.
• The decision on whether to award the critical illness provisions is one for the employer. Whilst the employer must primarily consider the OHS advice, the employer should consider all the circumstances of the case. In this regard, although an employee does not meet the medical criteria, an employer may still make a decision to award in exceptional circumstances.
• In exercising this discretion the employer must demonstrate the reasons why they are awarding the critical illness provisions. In this regard the employer should in particular consider the following:-
  • The individual’s sick leave record
  • The potential impact of an early return on the workplace efficiency and effectiveness
  • The possibility of making an accommodation to facilitate the return to work of an employee with a disability-related illness or condition³
• The final decision on the critical illness application will issue in writing directly to the employee by the employer.
• Where the critical illness provisions are not awarded, the decision letter will include details of the appeals process.

Critical Illness Appeal

An employee may appeal the decision to refuse the critical illness provisions in accordance with the procedures detailed below.  The Critical Illness Protocol and the Grievance Procedure for the relevant sector must be read in full prior to submitting an appeal.  In order to appeal the critical illness decision, an employee must apply to the employer in writing, setting out whether he/she is appealing the medical or the employer decision, within 30 days of receipt of the original critical illness decision.

1. Appeal of the employer decision: If the employer decision is being appealed the Grievance Procedures for the relevant sector must be followed.
2. Appeal of the medical decision: A number of registered specialists in occupational medicine, who are suitably qualified to assess medical fitness for work, have been selected and approved by the OHS and the Chief Medical Officer of the Civil Service to provide an appeal mechanism for employees who wish to appeal the critical illness medical decision. An employee may appeal the medical decision in accordance with the following procedures:

• • The employee writes to the employer within 30 days of receipt of the original critical illness decision setting out the grounds for appeal.
  • The appeal must only be based on the medical information presented to the OHS in the employee’s original application.  It is not possible to submit new medical evidence at this point of the process.
  • The medical decision can only be appealed in relation to the employee’s medical condition and only if the employee has been deemed medically unfit for work by the OHS.
  • The employer will refer the appeal to the OHS who will then refer the case to one of the independent registered specialists in occupational medicine.
  • This appeal will ordinarily be a file only review.
  • The cost of the appeal assessment is set at €100 and will be borne by the employee. If the appeal is successful the cost of the assessment will be refunded by the OHS.
  • Employees when making an appeal must forward to the employer a postal order/bank draft or cheque for the full cost of the assessment made payable to “Medmark Ltd. – CIP Appeal Account”.
  • The result of the approved registered medical practitioner’s assessment will be notified to the employer for action and the OHS for record purposes.
  • The final decision on the appeal lies with the employer, having considered the medical advice.

¹ In circumstances where there is no medical intervention.
² In the case of pregnancy related illness (natural or assisted pregnancy), the requirement for hospitalisation of two consecutive weeks will be reduced to two or more consecutive day of in-patient hospital/clinic care.
³ Employers are required in the case of an employee with a disability-related illness to take all reasonable steps in terms of making an accommodation to facilitate the employee’s return to work consistent with, for example, OHS advice and service requirements.