London Fire and Emergency Planning Authority, R (on the application of) v Board of Medical Referees

A medical appeal board must determine the issue raised by the firefighter’s appeal. It may examine the underlying diagnosis when deciding whether an accepted disablement is permanent, but it cannot reopen the fact of disablement itself. The board must collectively possess expertise covering the relevant medical conditions. An ancillary contractual requirement does not automatically affect jurisdiction. A procedural defect may be waived where it causes no unfairness. Medical reasons need not resemble a judicial judgment, but the report must fairly disclose the decision and why it was reached.

LFEPA sought judicial review of the Board’s determination that Mr Coogan, a firefighter, was permanently disabled under the Firefighters’ Pension Scheme 1992. The Board included two occupational physicians and a specialist in sleep apnoea, although the dispute ultimately concerned depression and the permanence of the disablement. LFEPA alleged defective constitution, failure to obtain further psychiatric evidence, inadequate reasons, and irrationality in the conclusion on permanence.

The court considered the scope of the Board’s jurisdiction, the expertise required by paragraph 2A(2) of Schedule 9, the effect of an unraised procedural objection, and whether the report adequately explained its conclusion.

1. Claim dismissed. The Board’s determination was not quashed. The interested party’s costs were summarily assessed at £27,500 inclusive of VAT. Permission to appeal was refused.
2. Under Marrion [2009] EWCA Civ 450, the Board’s jurisdiction is defined by the issue identified in the firefighter’s appeal. Here that issue was whether the disablement was likely to be permanent. The Board could investigate the underlying diagnosis in deciding that issue. The fact of disablement was outside the appeal because it was treated as given.
3. Paragraph 2A(2) of Schedule 9 requires the Board collectively to possess expertise covering the medical conditions relevant to the appeal. It does not necessarily require a separate specialist for every condition. The Board’s two experienced occupational physicians gave it sufficient expertise in this case.
4. Even if the constitution had been defective, the defect would have been a procedural irregularity rather than an absence of jurisdiction. LFEPA knew the constitution and raised no objection. There was no unfairness or breach of natural justice, so the court declined to quash. The Board was likewise not obliged to obtain another psychiatric report when several reports were already available and no concrete benefit was identified.
5. The criticism of the reasoning on diagnosis was justified because the Board did not identify the evidence supporting adjustment disorder or balance competing considerations. That omission did not invalidate the decision. A fair reading showed that the Board had accepted Dr Lockhart’s evidence and had sufficiently explained its conclusion on the central issue of permanence.

First-instance judicial review in the Administrative Court. The claim was dismissed and permission to appeal was refused.