What is the difference between Lower Tier and Upper Tier?

Lower Tier IHR: you are permanently incapable of performing the ordinary duties of a constable. Upper Tier IHR: you are permanently incapable of performing any regular employment. Upper Tier is a higher bar — it means you're unable to work in any capacity, not just as a police officer. Upper Tier pays more, because the pension has to cover more of your income for the rest of your life.

The Force Medical Adviser (FMA) or an Independent Medical Referee (IMR) — an occupational health doctor with specific IHR expertise. The assessment is based on medical evidence from your GP, treating specialists, and any specialist reports the FMA commissions. It's not a one-off check-up — it's a review of your full medical history relevant to the condition.

Can I appeal an IHR decision I disagree with?

Yes. The appeal route is to the Police Medical Appeal Board (PMAB), a statutory body composed of three medically-qualified members plus a lay chair. Appeals are common — both against a refusal (you want IHR, they said no) and against a tier decision (you want Upper Tier, they awarded Lower). PMAB re-examines the medical evidence and can uphold or vary the FMA decision.

What does IHR mean for my pension?

Depends on scheme and tier. In the 1987 and 2006 schemes, IHR (particularly Upper Tier) can add years of notional service to enhance the pension. In the 2015 CARE scheme, IHR gives you immediate access to the accrued pension (without the actuarial reduction that would normally apply for early retirement) plus a tier-dependent enhancement. Get a formal quote from the scheme administrator before accepting IHR — the numbers matter.

What if my condition improves?

In principle, an officer retired on Lower Tier IHR can be reviewed and, if fit for police duties again, could be required to return to service (though in practice this is rare and typically only in the first few years post-retirement). Upper Tier is generally treated as permanent for life. Once you're in receipt of the pension, review is uncommon after the first review cycle unless there's specific evidence of recovery.

Should I engage a Federation representative?

Yes, from the moment IHR is first raised. The Federation supports you through the medical process, the tier decision, and any PMAB appeal. Federation-scheme cover extends to the medical case if needed. Do not accept a tier decision without Federation review — small procedural errors can affect the outcome and the pension.

Police Medical Retirement (Ill-Health Retirement)

The two-tier IHR structure, assessment process, PMAB appeal route, and what it means for your pension.

Unofficial independent resource — always verify with official sources (College of Policing, your force, PFEW).

Reviewed by the BlueLineHub Editorial Team

Last reviewed: 29 May 2026 · Next review due: 29 November 2026

Reviewed by BlueLineHub Editorial

What is ill-health retirement for police officers?

Ill-health retirement (IHR) is the process by which a police officer whose health means they can no longer perform their duties is retired on medical grounds with immediate access to their pension. There are two tiers: Lower Tier IHR (permanent incapacity for the ordinary duties of a constable) and Upper Tier IHR (permanent incapacity for any regular employment). The Force Medical Adviser (FMA) or an Independent Medical Referee (IMR) makes the assessment; appeals go to the Police Medical Appeal Board (PMAB). The tier determines the pension enhancement and other benefits.

When IHR becomes an option

IHR is not the first-line response to a health problem. The usual pathway:

Referral to occupational health for the underlying condition.
Adjustments to duties, phased return, reasonable-adjustments plan under the Equality Act 2010.
Longer-term restricted duties if the adjustments aren't enough.
IHR only where restricted duties can't match the condition, and the incapacity is permanent.

“Permanent” in this context means expected to persist until age 65 or normal retirement (older regulations use 60). The FMA has to be able to say, on the balance of probabilities, that the officer will not recover to a state that allows return to police duties.

The assessment process

Application for IHR — usually initiated by the officer or force, sometimes recommended by treating specialists.
Medical evidence gathering — GP records, treating specialist reports, occupational health notes, sometimes specific specialist reports the FMA commissions.
FMA / IMR consultation — the assessor reviews the evidence and may see the officer in person or by video.
Written report — the FMA's opinion on: (a) whether the officer is permanently disabled from the ordinary duties of a constable (Lower Tier test); (b) whether the officer is also permanently disabled from any regular employment (Upper Tier test).
Chief officer decision — the report goes to the chief constable (or nominee) who takes the formal IHR decision.

Pension implications

Police Pension Scheme 1987

Lower Tier: pension paid based on actual service, with an added element.
Upper Tier: pension enhanced by notional additional service (typically to double actual service, up to a cap).

Police Pension Scheme 2006

Lower Tier: immediate pension based on accrued service.
Upper Tier: enhancement to prospective service to a defined age.

Police Pension Scheme 2015 (CARE)

Lower Tier: immediate access to accrued CARE pension without actuarial reduction.
Upper Tier: enhanced pension calculated on prospective accrual to normal retirement age.

PMAB appeal in detail

The Police Medical Appeal Board (PMAB) is a statutory body under the Police Pensions Regulations. Composition:

Three medically-qualified members.
A lay chair.
Meets in panel to hear appeals.

Appeal grounds:

The FMA opinion on incapacity was wrong.
The FMA opinion on permanence was wrong.
The FMA opinion on tier was wrong.
New medical evidence has emerged since the original assessment.

Appeals are heard on the basis of medical records and often further examination. The PMAB can uphold the FMA opinion, vary the tier, or refer back for reconsideration. Timelines: appeal usually filed within 28 days of the decision notice; hearing typically 3-9 months later.

What happens to your career

On IHR, you leave police service on medical grounds. Practical points:

You keep any earned entitlement to police service benefits (medal, association memberships).
Your pension is paid immediately.
Depending on tier and condition, you may be able to take up other employment (Lower Tier is silent on non-police work).
NARPO membership becomes relevant post-retirement.
Access to force welfare (EAP, Wellbeing Champion) usually ends at retirement, but Police Care UK and Oscar Kilo continue.

PTSD-driven IHR — a common route

A significant minority of IHR applications are driven by PTSD or Complex PTSD that has not responded to treatment. The FMA will typically require: full course of NICE- recommended therapy (EMDR or trauma-focused CBT), medication trial if appropriate, and time to reach the “permanent” conclusion. This process alone can take 18-24 months. See /wellbeing/ptsd-in-policing for the diagnostic and treatment detail.

Frequently asked

What is the difference between Lower Tier and Upper Tier?: Lower Tier IHR: you are permanently incapable of performing the ordinary duties of a constable. Upper Tier IHR: you are permanently incapable of performing any regular employment. Upper Tier is a higher bar — it means you're unable to work in any capacity, not just as a police officer. Upper Tier pays more, because the pension has to cover more of your income for the rest of your life.
Who assesses?: The Force Medical Adviser (FMA) or an Independent Medical Referee (IMR) — an occupational health doctor with specific IHR expertise. The assessment is based on medical evidence from your GP, treating specialists, and any specialist reports the FMA commissions. It's not a one-off check-up — it's a review of your full medical history relevant to the condition.
Can I appeal an IHR decision I disagree with?: Yes. The appeal route is to the Police Medical Appeal Board (PMAB), a statutory body composed of three medically-qualified members plus a lay chair. Appeals are common — both against a refusal (you want IHR, they said no) and against a tier decision (you want Upper Tier, they awarded Lower). PMAB re-examines the medical evidence and can uphold or vary the FMA decision.
What does IHR mean for my pension?: Depends on scheme and tier. In the 1987 and 2006 schemes, IHR (particularly Upper Tier) can add years of notional service to enhance the pension. In the 2015 CARE scheme, IHR gives you immediate access to the accrued pension (without the actuarial reduction that would normally apply for early retirement) plus a tier-dependent enhancement. Get a formal quote from the scheme administrator before accepting IHR — the numbers matter.
What if my condition improves?: In principle, an officer retired on Lower Tier IHR can be reviewed and, if fit for police duties again, could be required to return to service (though in practice this is rare and typically only in the first few years post-retirement). Upper Tier is generally treated as permanent for life. Once you're in receipt of the pension, review is uncommon after the first review cycle unless there's specific evidence of recovery.
Should I engage a Federation representative?: Yes, from the moment IHR is first raised. The Federation supports you through the medical process, the tier decision, and any PMAB appeal. Federation-scheme cover extends to the medical case if needed. Do not accept a tier decision without Federation review — small procedural errors can affect the outcome and the pension.