SPM50405 - Medical Referrals - Pregnancy related illness

Disputed pregnancy related incapacity

An employer can decide that their employee's MPP must start before the notified date of maternity absence if they think that the employee's absence from work in the 4 weeks immediately before her EWC is because of a pregnancy related illness. If they are not sure, or the employee disagrees with their decision, either:


  • the employer can ask HMRC for access to medical advice, or
  • the employee can ask HMRC for a decision under Section 8 of SSCTOFA1999/Article 7 ofSSCTFO(NI)1999.

A caseworker who is giving an opinion, or a Nominated Officer who is giving a decision, may also need to obtain medical advice.

Before the case is referred to Medical Services the Incapacity Reference Guide should be checked to see if this can clear the enquiry, see SPM50600.

If the advice in the guide is a clear "yes" or "no" take appropriate action.

If you cannot clear the enquiry using the guide, issue form SSP/SMP44 to the employee to get their consent to refer them to Medical Services.

Send a SMP42 to their doctor with a copy of the employee's consent.

When you receive the signed SMP42:


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Once Medical Services' advice has been received refer the file to the Nominated Officer with a covering minute to decide the start of the MPP and issue a notice of decision, DAA1 to both the employee and the employer.

Do not send a copy of Medical Services' advice to the employer or the employee, unless the evidence is needed to settle an appeal.

If Medical Services were unable to examine the employee and cannot offer an opinion about whether or not the illness is pregnancy related the Nominated Officer should support the employer's original decision on whether the illness is pregnancy related or not.