A guide to Industrial Injuries Disablement Benefits
DB1 April 2008
About this guide
This is one of several guides that give detailed information about social security benefits.
It is intended for professional advisers and members of the public who want to know more about benefits for people who are disabled as a result of injuries or diseases arising from work.
There is information about the Industrial Injuries scheme in leaflet “DWP 1004 – Industrial Injuries Disablement benefit – Help if you are ill or disabled because of your job”. You can get this leaflet from Jobcentre Plus offices.
This guide and the law
The guide gives a detailed explanation about benefits for people who are disabled as a result of accidents or diseases arising from work. It cannot cover every situation or problem, or provide a full interpretation of the rules in all cases. So it must not be treated as a complete and authoritative statement of the law.
The basis of the law for these benefits is contained in the Social Security Act 1998, the Social Security Contributions and Benefits Act 1992 and the Social Security Administration Act 1992. These Acts provide the framework for the detailed rules contained in regulations and orders made by the Secretary of State and approved by Parliament.
In the text there are references to the relevant Acts, Regulations or Schedules to allow you to consult the legislation. These documents are listed in Further information which tells you where you can consult them.
Introduction to the Industrial Injuries Scheme
- If you cannot act for yourself
- If someone who was disabled because of an accident at work or a prescribed disease dies
The Industrial Injuries Scheme provides non-contributory no-fault benefits for disablement because of an accident at work, or because of one of over 70 prescribed diseases known to be a risk from certain jobs. (See Appendix 1 for a list of the prescribed diseases.) The benefits payable under the scheme are sometimes described as Industrial Injuries Disablement Benefits (IIDB).
Benefits are paid to employees who are liable to pay income tax under Schedule E on wages, salaries or fees. [Legislation (1)]
Accidents or diseases which arise out of self-employment or service in HM forces are not included in the scheme. [Legislation (2)] [Legislation (3)]
The Department for Work and Pensions (DWP) has a similar scheme for trainees and the Home Office also has one for prisoners.
All Industrial Injuries Disablement Benefits, except Industrial Death Benefit, are tax free.
They are payable in addition to other incapacity and disability benefits but taken into account against income-related benefits.
The Industrial Injuries Disablement Benefits are:
- Industrial Injuries Disablement Benefit
- Constant Attendance Allowance
- Exceptionally Severe Disablement Allowance
- Reduced Earnings Allowance
- Retirement Allowance
- Industrial Death Benefit
- Unemployability Supplement
and benefits payable under the:
- Workmen’s Compensation (Supplementation) Scheme
- Pneumoconiosis, Byssinosis and Miscellaneous Diseases Benefit Scheme.
If you cannot act for yourself
If you wish to claim for any of these benefits but you are unable to act for yourself because of physical or mental incapacity, the Secretary of State can appoint someone to act on your behalf. If this happens,the person appointed is responsible for dealing with all your social security affairs, including claiming and receiving benefits. They are also responsible for notifying any changes of circumstances which may affect your benefit. [Legislation (4)]
If you are able to handle your own affairs but want someone else to collect your benefit for you regularly, you may be able to make arrangements with your bank, building society or, if you have a Post Office® card account, the Post Office®. Please ask them to help you with this. [Legislation (5)]
If you are paid by order book, you should consider having your benefit paid directly into an account. For further details please read the ‘How you are paid’ paragraphs of this guide. If you continue to be paid by order book, you can arrange for someone else to collect your money.
If someone who was disabled because of an accident at work or a prescribed disease dies
If someone who has not claimed Industrial Injuries Disablement Benefit dies, but they would have qualified for this benefit, a claim can be made on their behalf, for example by a widow or surviving civil partner. [Legislation (6)]
If someone who has claimed Industrial Injuries Disablement Benefit dies, any outstanding benefit can be paid to a third party, for example an executor or next of kin. [Legislation (7)]
Industrial Injuries Disablement Benefit
Eligibility
Industrial Injuries Disablement Benefit is a weekly benefit paid to people who become disabled because of an accident at work or due to certain prescribed diseases caused by their job on or after 5 July 1948.
- See Appendix 1 for a list of prescribed diseases.
The amount you get depends on how badly you are disabled as a result of the industrial injury or disease.
Employed earner’s employment
Only employed earners, or people who can be treated as employed earners, are covered by the Industrial Injuries Scheme. [Legislation (8)] [Legislation (9)]
An employed earner is a person who is gainfully employed in Great Britain either under a contract of service or is an office holder (for example, a company director), and is liable to pay income tax under Schedule E on their salary, wages or fees. [Legislation (10)]
Some people who are not employed earners are treated as though they were for the purposes of the scheme, for example:
- special constables, who are not paid and so cannot be said to be working for reward
- agency staff who are self-employed under a contract for services but are still liable to pay Class 1 National Insurance (NI) contributions in respect of their earnings. Legislation (11)]
How to claim Industrial Injuries Disablement Benefit
You do not need to have paid any NI contributions in order to claim Industrial Injuries Disablement Benefit.
If your accident or disease is caused by self-employed work or employment not treated as employed earner’s employment, you are not covered by the scheme.
Trainees who have an accident or contract a disease during the course of a work-based training programme cannot get industrial injuries benefits. But there is a similar scheme run by the DWP for these people.
You cannot get industrial injuries benefits for accidents which occur or diseases contracted while serving in HM forces. You may be able to get compensation through the War Pensions Scheme or Armed Forces Compensation Scheme. [Legislation (12)]
If you are not sure whether you are covered you should ask at your social security office.
The decision maker will give an informal opinion on employed earner’s employment and if it is accepted that the employment is as an employed earner no further question on employment status arises.
If it is not accepted that the employment is as an employed earner, any claim to benefit will be disallowed. If you dispute a disallowance, your papers will be sent to the Inland Revenue for a formal decision on employed earner’s employment.
Residence in Great Britain
You must normally have had the accident or got the disease in Great Britain, but you may still get benefit if:
- you were a mariner, airman, worked on the continental shelf of the United Kingdom, or worked in another European Union (EU) country or Norway [Legislation (13)] [Legislation (14)]
- your employer was paying Class 1 NI contributions for you while you [Legislation (15)] were working out of the country
- you were paying special Class 2 contributions as a volunteer [Legislation (16)] development worker
- you worked in one of the countries with which Great Britain has an agreement covering industrial injuries.
Obtaining a claim form
Contact your social security office for a claim pack. You can get the address of your nearest office from the post office® or by looking in the business section of the phone book under Jobcentre Plus or social security.
- You can also access the claim packs on the DWP website. The address is www.dwp.gov.uk
The claim packs are:
| BI 100A | Industrial Accidents |
| BI 100PD | Prescribed Industrial Diseases |
Not every social security office deals with these claims. You may be referred to another office that deals with this benefit.
When to claim
If you think you have a disease caused by your job, claim Industrial Injuries Disablement Benefit straight away.
If you have an accident, claim 2 months after the accident. This is because you cannot get benefit for the first 15 weeks (90 days not including Sundays) after your accident and you will not normally be medically examined until after this time.
If you have any relevant medical evidence, send it with your claim form but do not delay claiming by trying to get a fresh report.
Do not delay claiming. If you do you may lose some benefits. This is because Industrial Injuries Disablement Benefit cannot be paid:
- for a period more than 3 months before the date of your claim [Legislation (17)]
- more than one month before the date of claim, if you are already receiving Industrial Injuries Disablement Benefit for other accidents or diseases. [Legislation (18)]
- Different rules apply to claims for occupational deafness. You cannot get benefit for any period before the date of claim – see the ‘Prescribed diseases’.
The date of your claim is the date your fully completed claim form is received by a Jobcentre Plus or social security office. It is very important that you fill in all the details on the form carefully and return it to your Regional Industrial Injuries Benefit Delivery Centre as soon as possible. [Legislation (19)]
If you want help filling in your claim form, or any part of it, ring the Benefit Enquiry Line for people with disabilities. The phone number is 0800 88 22 00.
Industrial accidents
- Notification of accident
- Accident declarations
- The accident declaration decision
- Making a benefit claim for an industrial accident
- The decision on your claim
- Payment of benefit
- Effects of Industrial Injuries Disablement Benefit on other benefits
An ‘accident’ for Industrial Injuries Disablement Benefit purposes means any unintended happening or incident at work that has arisen out of and in the course of your employment, and has resulted in a personal injury.
It must have arisen from employed earner’s employment that took place on or after 5 July 1948. [Legislation (20)]
You can only get benefit if the accident results in personal injury (also described as loss of faculty). It does not matter if the effect of the injury is immediate (for example, if you break your leg in a fall) or is delayed (for example, a blow to the knee which leads to impaired mobility at a later time).
Generally an accident which happens when you are at work is accepted as having happened as a result of your work, unless there is some evidence that this is not so. Whether or not you are considered to be at work at a particular time depends on the circumstances in each case. For example,you cannot normally be regarded as being at work when you are travelling to or from work, but you may be if you are in transport provided by your employer. [Legislation (21)]
An accident can be treated as having happened when you were at work and as a result of your work if it occurred:
- because you were doing something you were employed to do
- or because your work put you at special risk
- or while you were helping in an emergency, for instance in rescue work at any premises used for your employer’s business. [Legislation (22)]
If you were doing something which your employer does not allow you to do, or the rules for your job do not allow you to do, the accident may still be treated as having happened during, and as a result of your work, if what you were doing was done for the purpose of your employer’s business and was within the scope of your job.
In some other unusual cases, such as ‘skylarking’ by workmates, an accident can be covered if it happens through no fault of your own while you are at work.
Notification of accident
If you suffer an accident at work you are required to give notice of the accident to one of the following people:
- your employer
- any foreman or other official in charge
- any person designated by your employer for that purpose.
The following details must be provided either orally or in writing:
- your full name, address and occupation
- the date, time and place where the accident happened
- the cause and nature of the injury. [Legislation (23)] [Legislation (24)]
An accident book or an equivalent electronic record must be maintained by any employer who:
- owns or occupies any mine or quarry
- owns or occupies any premises to which any of the provisions of the Factory Act 1961 apply
- normally employs ten or more people at the same time or about the same premises in connection with a trade or business carried on by that employer.
The accident book or electronic record must be readily accessible.
Accident declarations
You can apply for a declaration that your accident is an industrial accident.
How to apply
An accident declaration is not a claim for benefit but will be helpful if you decide to claim benefit for your accident in the future.
If you wish to claim Industrial Injuries Disablement Benefit for an accident at work you should complete a form BI100A.
If you want to have your accident declared as an industrial accident immediately and you do not need to claim benefit until later you should fill in parts Parts 1-7 of the BI 100A only.
You can get a claim form from Jobcentre Plus offices or via the internet at www.direct.gov.uk.
How an accident declaration is dealt with
Once your regional Industrial Injuries Benefit Delivery Centre has received your application for an accident declaration, they will normally write to your employer to verify the accident. Confirmation is needed of the following:
- the time, date and place of the accident
- that the accident arose out of and in the course of your employment
- that your employment was employed earner’s employment
- that the employment was in Great Britain or was covered by special provisions.
The accident must have happened in the course of your employment while you were doing something which: [Legislation (25)]
- you were authorised, expressly or by implication, to do by your employer
- or was so closely related to your employment that it was reasonable for you to be doing it
- or is covered by the special provisions regarding actions in an emergency, transport provided by the employer, breach of the rules or accident caused by another person’s behaviour.
If your employer is no longer trading, and the location of their records is not known, you will be asked to provide details of any witnesses to the accident.
The accident declaration decision
Once the decision maker in the office has all the relevant information about the accident, they will then make their decision and notify you in writing.
The decision maker may refuse to decide the accident question if satisfied that it is unlikely to be needed for any claim to benefit. [Legislation (26)]
If you disagree with the decision
- See NI260 DMA – ‘A guide to Dispute, Supersession and Appeal’.
Making a benefit claim for an industrial accident
When to claim
If you have an accident, claim 3 months after the accident. This is because you cannot get benefit for the first 15 weeks (90 days not including Sundays) after your accident and you will not normally be medically examined until after this time.
If you have any relevant medical evidence send it with your claim form but do not delay claiming by trying to get a fresh report.
Do not delay claiming. If you do you may lose some benefits. This is because Industrial Injuries Disablement Benefit cannot be paid:
- for a period more than 3 months before the date of your claim
- or if you are already in receipt of Industrial Injuries Disablement Benefit for other accidents or diseases, more than one month before the date of claim [Legislation (27)]
How to claim
Contact your social security office for a claim form BI100A. You can get the address of your nearest office from the post office or by looking in the business section of the phone book under Jobcentre Plus or social security.
- You can also access form BI100A on the DWP website. The address is www.dwp.gov.uk
The date of your claim is the date your fully completed claim form is received by a social security office. It is very important that you carefully fill in all the details on the form and return it to your Regional Industrial Injuries Benefit Delivery Centre as soon as possible. [Legislation (28)]
If you want help filling in your claim form, or any part of it, ring the Benefit Enquiry Line for people with disabilities. The telephone number is 0800 88 22 00.
You will be sent a written acknowledgement that the claim form has been received.
If the accident has already been investigated we will not have to write to your employer again. If it has not we will need to contact your employer for verification of the accident.
Once you have made a claim and the decision maker has accepted that you have suffered an industrial accident, you may then be asked to attend a medical examination. [Legislation (29)]
If you are asked to attend a medical examination and you fail to turn up without good cause, your claim will be disallowed. [Legislation (30)]
About the medical examination
Your medical examination will be carried out by one or possibly two experienced medical practitioners.
These doctors are specially trained in industrial injuries disablement matters.
If you can travel, you will be told when and where to go for the examination. You will be told what out-of-pocket expenses you can claim. If you are not fit to travel alone, someone can travel with you. [Legislation (31)]
If you are not fit to travel, you can also request an examination at home.
The medical examination will be held in private but you may be able to take a companion if the doctor allows it. Occasionally you may be asked if an observer can be present.
You can give the doctor any evidence which was not included with your claim form, if you think it will help them to give an opinion on your disablement.
If you have attended a hospital following an industrial accident, the doctor may seek further information from the hospital. Hospital case notes may be requested by the doctor to assist in giving an opinion.
The doctor could also ask for a report from your GP.
The doctor will take a statement from you and send a written report to the decision maker based upon the examination and any other medical evidence. The doctor will give an opinion on whether you have suffered a loss of faculty as a result of the accident and, if so, advise on the level of your disablement and how long it is expected to last. The doctor will also provide an explanation for the decision maker about how they arrived at that opinion.
What is a loss of faculty?
Loss of physical or mental faculty means some loss of power or function of an organ of the body. Loss of faculty can include disfigurement even when this causes no bodily handicap. Whether a loss of faculty results in disability is decided by comparing your condition as a result of the accident with the condition of a normal healthy person of the same age and sex. [Legislation (32)]
Degree of disablement
Your disablement is assessed as a percentage up to 100%.
The degree of disablement for certain defined injuries is laid down in the Regulations. For example, for serious disablement such as loss of both hands or loss of sight the degree of disablement is 100%, for the loss of one hand it is normally 60%, and for the loss of an index finger it is usually 14%. The percentages listed in Regulations for different disablements is in Appendix 2. [Legislation (33)]
The degree of disablement for injuries not listed in the Regulations is arrived at by comparing them with these standards.
The medical advice or assessment takes account of all disabilities resulting from the industrial accident. Where your disability also results from some other cause which arose before the accident, the degree of disablement which would in any event be present due to that other cause is not counted, but the interaction between the two causes is included in the assessment.
For example, a miner who has had considerable trouble with his back for many years and who is known to have lumbar spondylosis, injures his back lifting a heavy weight at work.
The doctor considers a gross assessment of disablement for injury to the spine and deducts an amount for the disablement already present due to the earlier back problems. [Legislation (34)]
If your disablement is 11% or more, and some other condition arises after the accident but is not directly caused by it, any increase in your disablement due to the accident as a result of that other cause is also used to work out your disablement.
For example, a man fractured his left forearm in a fall at work. After the industrial accident he was involved in a traffic accident and fractured his left collar bone.
The doctor considers an assessment of disablement for injury to the forearm and if that assessment is over 11% the doctor adds a further assessment for the extent that the later fracture increases the man’s disability.
You may be given a ‘final’ assessment of disablement for life if your disability is assessed as permanent and is unlikely to change. Or where you are likely to make a full recovery the assessment may be final but for a limited period. Or you may be given a provisional assessment for a limited period at the end of which you will be re-examined and your disablement assessed again. [Legislation (35)]
The decision on your claim
After the medical examination, your claim will be decided by a decision maker. The decision maker will look at the doctor’s advice and any other available evidence.
Regional Industrial Injuries Benefit Delivery Centre office will write to tell you the decision on your claim, the amount of any benefit you will get and the period for which you will receive benefit.
The decision only takes account of your physical or mental condition. Basic Industrial Injuries Disablement Benefit is not affected by what type of job you do or any loss of earnings. It can be paid whether or not you have returned to work and it does not depend on your earnings.
Loss of earnings and other circumstances may, however, mean you can get one or more of the other benefits described later in this guide.
If you disagree with the decision on your claim
Payment of benefit
How much benefit you will get
The amount of benefit you get depends on how badly you are disabled by the accident.
Industrial Injuries Disablement Benefit cannot be paid for the first 15 weeks (90 days not including Sundays) after the date of your accident. [Legislation (36)]
You will not get benefit if your disablement is assessed at less than 14%. [Legislation (37)]
But you may be able to get benefit if you have had more than one accident or disease and the total disablement, when the effects of all the accidents and diseases are added together, is 14% or more. This is known as aggregation. [Legislation (38)]
If your disablement is at least 14% your benefit will be paid as a weekly pension.
If your disablement is:
between 14% and 19% you will get a pension at the 20% rate, 20% or over it will be rounded up or down to the nearest 10%. [Legislation (39)]
The following table provides a breakdown of the percentage assessment and percentage payable:
| Percentage assessment | Percentage payable |
|---|---|
| 14 – 24 % | 20% |
| 25 – 34 % | 30% |
| 35 – 44 % | 40% |
| 45 – 54 % | 50% |
| 55 – 64 % | 60% |
| 65 – 74 % | 70% |
| 75 – 84 % | 80% |
| 85 – 94 % | 90% |
| 95 – 100% | 100% |
The maximum rate payable for Industrial Injuries Disablement Benefit is 100% even if you have several assessments which add up to over 100%.
For current rates see 'Social Security Benefit Rates' (BRA5DWP)
How you are paid
Our policy is to pay all benefits directly into an account.
This is the safest way to pay you and lets you choose how and when you get your money. You can use a bank or building society.
You may be able to use a cash machine, which will usually mean you can get your money at any time of the day or night.
There are arrangements with banks and building societies so that you can collect cash from some of their accounts at your Post Office® branch.
The Post Office® also provides a bank account that we can pay benefits into. With this account you can only collect your money in cash from Post Office® branches.
The other advantages of having your money paid into an account are:
- you can get your money from many different places
- from some accounts you could have regular bills paid. This could save you money but you will need to make sure that there is enough money in your account to pay the bills. If not, you may be charged a fee
- using an account may help you save.
The account can be:
- in your name, or
- in the name of your partner. We use partner to mean a person you are married to or a person you live with as if you were married to them, or a civil partner or a person you live with as if you are civil partners, or
- in the names of both yourself and your partner, or
- in the name of the person acting on your behalf, or
- in the names of both yourself and the person acting on your behalf.
Benefit is paid either every 4 weeks, every 13 weeks or every week.
If you have a bank or building society account but you do not wish to use it, for example a joint account, any bank or building society will help you open an account that suits you better. Remember to ask whether their accounts allow you to get your money from the Post Office®, if this is important to you.
Basic bank account
If you have had problems opening a current account, or if you are worried about being overdrawn, you could ask any bank or building society about opening a basic bank account.
These are sometimes called introductory or starter accounts and are available from all major banks.
These accounts offer free banking but overdrafts are not available.
You can use these accounts to pay money in, pay bills automatically and get cash out.
Many basic bank accounts also allow you to get cash from Post Offices®.
Post Office® card account
This is a simple bank account that can only have benefit/pension/allowance/credit payments paid into it.
You can only collect payment from it in cash at a Post Office® branch.
You will not have a cheque book and cannot withdraw money at a cash machine.
You will not be able to run up an overdraft, pay bills by Direct Debit or Standing Order, or have your salary or any other money paid in.
The account can only be in your name.
You may be able to arrange with the Post Office® for someone else to collect your benefit regularly from this account.
If your circumstances change
A decision can be looked at again at any time if your condition has changed.
If the condition for which you are getting benefit improves you must tell us straight away.
If you feel your condition has got worse and you want us to have another look at the decision, complete and return form BI168, which you can get from your social security office.
If you are receiving Industrial Injuries Disablement Benefit you must also tell us if:
- you marry, remarry or form a civil partnership and change your name
- you change your address
- you leave the country
- you go into prison.
If any of these Regional Industrial Injuries Benefit Delivery Centre or social security office straight away. [Legislation (40)]
If you leave the country
If you leave the country, Industrial Injuries Disablement Benefit is payable while you are away. If you intend to be away for less than 3 months, and you are paid by order book, you should consider having your benefit paid directly into an account.
- For further details please read the ‘How you are paid’ paragraphs of this guide. [Legislation (41)]
If you intend to be away for more than 3 months, payment of your benefit will be made by International Pensions Centre 3 (IPC3).
You will be asked how you want your payments to be made while you are away. You can choose between:
- Direct Payment to a United Kingdom (UK) bank, building society or Post Office® card account every 4 or 13 weeks
- payable orders sent directly to you every 4 or 13 weeks while you are away
- Transcontinental Automated Payments (TAPS), if the country has this arrangement with Jobcentre Plus
- payment to a nominee
- payment when you return to the UK.
You must let us know when you return to the UK.
If you go to prison
If you go into prison, you must let us know the date you were admitted.
Payment of Industrial Injuries Disablement Benefit is suspended during any period of imprisonment.
When you are released let us know the date. Arrears of Industrial Injuries Disablement Benefit may be paid for the period of imprisonment subject to a maximum of one year’s benefit. [Legislation (42)]
If you die
If you die, someone should let us know straight away. If you have an order book, they should send it back straight away. They should not cash it.
Effects of Industrial Injuries Disablement Benefit on other benefits
Your basic Industrial Injuries Disablement Benefit does not affect any other National Insurance benefits such as:
- Incapacity Benefit
- Contribution-based Jobseeker’s Allowance
- Retirement Pension.
But Industrial Injuries Disablement Benefit may affect income-related benefits that you or your partner receive such as:
- Income Support
- Income-based Jobseeker’s Allowance
- Pension Credit
- Housing Benefit
- Council Tax Benefit
- Working Tax Credit
- Child Tax Credit.
Industrial Injuries Disablement Benefit may also affect how much War Pension you get, if you are entitled to both.
Prescribed diseases
- Introduction
- Which diseases are prescribed
- Questions arising on a prescribed diseases claim
- Making a benefit claim for a prescribed disease
- The decision on your claim
- Payment of benefit
- Effects of Industrial Injuries Disablement Benefit on other benefits
Introduction
The law provides for payment of benefits to people who are suffering from certain diseases contracted in the course of certain types of employment. These diseases are referred to as prescribed diseases (PDs) and are listed in Regulations. [Legislation (43)] [Legislation (44)]
A disease or injury is prescribed when the Secretary of State is satisfied that it is a risk arising from a person’s occupation and not a risk common to everybody. [Legislation (45)]
There is no entitlement to benefit in respect of a disease if it is not listed in the Regulations, or if the person’s job is not listed against the particular disease. But there may be entitlement to benefit under the industrial accident provisions if a disease has been caused as a result of an accident (see Industrial Accidents).
The date of onset or development of a prescribed disease, which may have resulted in incapacity, loss of faculty or death, must be on or after 5 July 1948. But benefit can be paid for certain diseases resulting from employment before 5 July 1948.
- See Accidents and Diseases before 5 July 1948 – Workmen’s Compensation (Supplementation) Scheme [Legislation (46)]
If you are told that you are not entitled to benefit for a certain disease, it does not mean you do not have the disease for which you claimed. What you are being told is that you do not meet the criteria laid down for receiving benefit for that disease. These criteria are laid down so that it can be presumed that your job caused the prescribed disease in question.
For example, if a coal miner is refused benefit for chronic bronchitis and emphysema this does not mean he does not have those illnesses. It means that, for the purposes of the benefit scheme, his illness cannot be presumed to have been caused by his job.
This is especially important for diseases common in the population at large, where it is known that some workers would have got the disease whatever job they did.
Which diseases are prescribed
Prescribed diseases are grouped according to their causes. There are four groups of causes, each identified by a letter, and each prescribed disease has a number. The groups are:
- A for a physical cause
- B for a biological cause
- C for a chemical cause
- D for any other cause.
A full list of the prescribed diseases and types of occupation which are covered by the scheme is set out in Appendix 1. [Legislation (47)]
Questions arising on a prescribed diseases claim
The primary questions arising on a prescribed disease claim are:
- Is the disease a prescribed disease?
- Is the disease prescribed in relation to you? This is called the prescription question and involves considering whether your employment could have caused the disease, and whether the employment was employed earner’s employment
- Are you suffering from the disease, or have you suffered from the disease? This is called the diagnosis question
- Is the disease due to the nature of your employment?
- When was the date of onset of the disease?
- Have you suffered a relevant loss of faculty due to the disease?
If you have an attack of the same disease that you have previously been paid Workmen’s Compensation for, you may be able to get benefit under the Industrial Injuries Scheme if you satisfy the rules described above and if it is decided you have suffered a fresh attack of the disease. [Legislation (48)]
If you cannot get benefit under the Industrial Injuries Scheme you may be able to get benefit under the Workmen’s Compensation (Supplementation) Scheme. See the section on ‘Workmen’s Compensation’.
Presumption
Most prescribed diseases are presumed to be due to the nature of a person’s employment.
If you have contracted a prescribed disease the presumption applies if you were employed in a prescribed occupation and you were employed on the date of onset of the disease or at any time within one month of the date of onset of the disease, unless the decision maker can prove that the disease was not due to the nature of your employment.
To do this the decision maker must have sufficient proof to establish this on the balance of probabilities. The decision maker must be satisfied that, taking into account all the relevant evidence, it is more probable that the disease was not due to the nature of your employed earner’s employment than it was. [Legislation (49)]
If the presumption does not apply, the onus is on you to establish on the balance of probabilities that the disease was due to the nature of your employment.
Presumption does not apply to prescribed diseases A12 and D5. [Legislation (50)]
Presumption applies in different ways to prescribed diseases A10, B5, D1, D2, D4 and D12.
Making a benefit claim for a prescribed disease
When to claim
You can make a claim at any time on or after the date you think you contracted the prescribed disease.
If you have any relevant medical evidence send it with your claim form but do not delay claiming by trying to get a fresh report.
Do not delay claiming. If you do you may lose some benefits. This is because Industrial Injuries Disablement Benefit cannot be paid:
- for a period more than 3 months before the date of your claim
- or if you are already in receipt of Industrial Injuries Disablement Benefit for other accidents or diseases, more than one month before the date of claim. [Legislation (51)]
How to claim
You can get a claim form from Jobcentre Plus offices or via the internet at www.direct.gov.uk.
The date of your claim is the date your fully completed claim form is received by a Jobcentre Plus or social security office. It is very important that you fill in all the details on the form carefully and return it to your Regional Industrial Injuries Benefit Delivery Centre as soon as possible.
There is one claim pack BI 100PD for claiming Industrial Injuries Disablement Benefit for a prescribed disease.
How claims are decided
When you have completed the claim form, return it to the nearest Jobcentre Plus or social security office. If you have any medical evidence relevant to your claim, you should send it with the claim form.
You will be sent a written acknowledgement that the claim form has been received.
We may have to contact your employer(s) to confirm:
- your periods of employment
- that your employment was employed earner’s employment
- that you worked with any of the listed tools or in conditions which are relevant for your claim.
If you satisfy the prescription question
Your papers will be referred to medical services and you may be asked to attend a medical examination. [Legislation (52)]
If you are asked to attend a medical examination and you fail to turn up without good cause, your claim will be disallowed. [Legislation (53)]
If you do not satisfy the prescription question
Your claim will be disallowed and we will write to tell you this.
Fast track cases
Claims for prescribed disease D3 and for all other diseases where the person is terminally ill, are treated as fast track cases. These cases are given priority at all times.
Specific criteria
Certain prescribed diseases have specific criteria which must be met to make a claim.
Occupational deafness
To meet the criteria for occupational deafness you must have worked in employed earner’s employment in one or more of the prescribed occupations: [Legislation (54)]
- at any time on or after 5 July 1948
- for a total of at least 10 years.
You must claim within 5 years of leaving the employed earner’s employment which may have caused the deafness. [Legislation (55)]
Any claims made outside of this period will be disallowed but if you return to a prescribed occupation you can claim again when you satisfy the rules.
If you claimed at least 3 years ago and that claim was turned down because you had not satisfied the work rules you can claim again as long as you worked in one of the listed jobs within the last 5 years. [Legislation (56)]
If by waiting for the 3 years to pass it would be more than 5 years since you worked in a listed job, you do not have to wait 3 years before claiming again.
If you claim again, all the work and medical rules will be applied in the same way as if it was your first claim.
Chronic bronchitis and emphysema
To satisfy the prescription for chronic bronchitis and emphysema you must have worked:
- in employed earner’s employment on or after 5 July 1948
- and for a total of 20 years underground in a coal mine.
It does not have to be 20 years with the same employer or be one unbroken period. Periods of employment can be added together and some breaks in employment can be ignored.
Periods of work before 5 July 1948 can count towards the 20 year total.
Time worked on the surface does not count.
Your claim will be disallowed if you do not satisfy the above conditions.
If you got the disease from employment which ended on or before 4 July 1948, you cannot get Industrial Injuries Disablement Benefit.
Asthma
To qualify for Industrial Injuries Disablement Benefit for occupational asthma as a prescribed disease, you must have worked in employed earner’s employment in a prescribed occupation involving exposure to the sensitising agent which may have caused the asthma. [Legislation (57)]
You must claim within 10 years of leaving the employed earner’s employment which may have caused the asthma.
If you do not satisfy the 10 year rule, your claim will be disallowed.
Disallowance on the 10 year rule does not prevent you from making another claim. This is because the 10 year period starts again if you work again in an occupation involving exposure to a sensitising agent.
About the medical examination
Your medical examination will be carried out by one or possibly two experienced medical practitioners. These doctors are specially trained in industrial injuries disablement matters.
If you can travel, you will be told when and where to go for the examination. You will be told what out-of-pocket expenses you can claim. If you are not fit to travel alone, someone can travel with you. If you are not fit to travel, you can also request an examination at home.
The medical examination will be held in private but you may be able to take a companion if the doctor allows it. Occasionally you may be asked if an observer can be present. You can give the doctor any evidence which was not included with your claim form, if you think it will help them to give an opinion on your disablement.
If you have attended a hospital in connection with the disease you are claiming for, the doctor may seek further information from the hospital. Hospital case notes may be requested by the doctor to assist in giving an opinion. The doctor could also ask for a report from your GP.
The doctor will take a statement from you and send a written report to the decision maker based upon the examination and any other medical evidence.
The doctor will advise on:
- whether you are suffering from a prescribed disease, and if so;
- whether you have suffered a loss of faculty from the disease, and if so;
- the level of your disablement and how long it is expected to last.
If the doctor has advised that you are suffering from a prescribed disease he will also advise on the date of onset of the disease.
The doctor will also provide an explanation for the decision maker as to how they arrived at their opinion.
The doctor will also advise if, in their opinion, the disease is due to the nature of your employed earner’s employment. This is called causation.
Special arrangements
For some prescribed diseases you will need to have tests before the medical examination.
Occupational deafness
In claims for occupational deafness, we will arrange for you to have a hearing test to see if you have an average hearing loss of at least 50 decibels in both ears due to damage to the inner ear. In at least one ear this must be due to noise at work. If the doctor advises that you satisfy this test you will then have a medical examination. If not, your claim will be sent back to the decision maker who will consider whether to disallow it.
Chronic bronchitis and emphysema
In claims for chronic bronchitis and emphysema, it may be necessary for you to have a breathing test. If the doctor advises that you satisfy this test you will then have a medical examination. If not, your claim will be sent back to the decision maker who will consider whether to disallow it.
Pneumoconiosis
In claims for pneumoconiosis, we will normally arrange for you to have an X-ray of your chest. If the X-ray and other evidence shows that you may have the disease you will then have a medical examination. If the X-ray shows no trace of the disease your claim will be sent back to the decision maker who will consider whether to disallow it.
What is a loss of faculty?
Loss of physical or mental faculty means some loss of power or function of an organ of the body. Loss of faculty can include disfigurement even when this causes no bodily handicap. Whether a loss of faculty results in disability is decided by comparing your condition as a result of the disease with the condition of a normal healthy person of the same age and sex. [Legislation (58)]
What is the date of onset?
The date of onset of a disease is the date you first suffered a loss of faculty from the disease. The date of onset may be earlier than the date that benefit is actually paid from. This is because the date benefit is paid from is governed by time limits for claiming and other criteria. [Legislation (59)]
Degree of disablement
The medical advice or assessment takes account of all disabilities resulting from the disease. Where your disability also results from some other cause which arose before you got the disease, the degree of disablement which would in any event be present due to that other cause is not counted, but the interaction between the two causes is included in the assessment.
For example, an assembly worker who had previously fractured her right arm in a road accident is diagnosed as having prescribed disease A4 (cramp of the hand or forearm) in the same arm.
The doctor considers a gross assessment of disablement for upper limb dysfunction and deducts an amount for the disablement that remains due to the earlier accident.
If your disablement is 11% or more, and some other condition arises after the accident or disease but is not directly caused by it, any increase in your disablement due to the disease as a result of that other cause is also used to work out your disablement.
For example, a man who is diagnosed as having prescribed disease A11 (vibration white finger) has also developed osteoarthritis in one of his fingers at a later date.
The doctor considers an assessment of disablement for upper limb dysfunction and if that assessment is over 11% the doctor adds a further assessment for the extent that the osteoarthritis increases the man’s disability. [Legislation (60)]
Different types of assessment
You may be given a ‘final’ assessment of disablement for life if your disability is assessed as permanent and is unlikely to change. Or where you are likely to make a full recovery the assessment may be final but for a limited period. Or you may be given a provisional assessment for a limited period at the end of which you will be re-examined and your disablement assessed again. [Legislation (61)]
The decision on your claim
After the medical examination your claim will be decided by a decision maker. The decision maker will look at the doctor’s advice and any other available evidence.
Your Regional Industrial Injuries Benefit Delivery Centre will write to tell you the decision on your claim, the amount of any benefit you will get and the period for which you will get benefit.
The decision only takes account of your physical or mental condition. Basic Industrial Injuries Disablement Benefit is not affected by what type of job you do or any loss of earnings. It can be paid whether or not you have returned to work and it does not depend on your earnings.
Loss of earnings and other circumstances may, however, mean you can get one or more of the other benefits described later in this guide.
If you disagree with the decision
Payment of benefit
How much benefit you will get
The amount of benefit you get depends on how badly you are disabled by the disease.
Industrial Injuries Disablement Benefit cannot be paid for the first 15 weeks (90 days not including Sundays), after the date of onset of the disease. [Legislation (62)]
The exception to this is in claims for occupational deafness, when payment can only be made from the date the claim form is received by Jobcentre Plus, and in claims for diffuse mesothelioma, when payment can be made from the date you were first disabled by the disease but not for more than 3 months before the date of your claim. [Legislation (63)]
You will not normally get benefit if your disablement is less than 14%. [Legislation (64)]
But you may be able to get benefit if you have had more than one accident or disease and the total disablement, when the effects of all the accidents and diseases are added together, is 14% or more. This is known as aggregation.
If your disablement is at least 14% your benefit will be paid as a weekly pension. [Legislation (65)]
If your disablement is:
between 14% and 19% you will get a pension at the 20% rate
20% or over it will be rounded up or down to the nearest 10%. [Legislation (66)]
The following table provides a breakdown of the percentage assessment and percentage payable:
| Percentage assessment | Percentage payable |
|---|---|
| 14 – 24 % | 20% |
| 25 – 34 % | 30% |
| 35 – 44 % | 40% |
| 45 – 54 % | 50% |
| 55 – 64 % | 60% |
| 65 – 74 % | 70% |
| 75 – 84 % | 80% |
| 85 – 94 % | 90% |
| 95 – 100% | 100% |
The maximum rate payable for Industrial Injuries Disablement Benefit is 100% regardless if the total assessment is over 100%.
For current rates see 'Social Security Benefit Rates' (BRA5DWP)
Rules for specific diseases
Pneumoconiosis and byssinosis
For the respiratory diseases pneumoconiosis, byssinosis you can get benefit if your disablement is assessed as atleast 1%. [Legislation (67)]
Diffuse mesothelioma
For the respiratory disease diffuse mesothelioma your disablement will be assessed as being 100% [Legislation (67)]
Occupational deafness
To get benefit for occupational deafness, your disablement must be assessed as 20% or more. [Legislation (68)]
If the assessment is less than 20% for occupational deafness it cannot be aggregated with any other assessment of disablement. [Legislation (69)]
Chronic bronchitis and emphysema
If you claim for chronic bronchitis and emphysema you must not already be getting any benefit which takes full account of this condition.
For example, if you have been awarded Industrial Injuries Disablement Benefit for pneumoconiosis and your disablement from pneumoconiosis, or pneumoconiosis with tuberculosis, has been assessed at 50% or more you may have already had your benefit increased to take full account of bronchitis/emphysema.
If so you will not qualify separately for bronchitis/emphysema but if you think your bronchitis/emphysema has got worse, you should apply to have your assessment for pneumoconiosis looked at again in case it can be increased.
How you are paid
Our policy is to pay all benefits directly into an account.
This is the safest way to pay you and lets you choose how and when you get your money. You can use a bank or building society.
You may be able to use a cash machine, which will usually mean you can get your money at any time of the day or night.
There are arrangements with banks and building societies so that you can collect cash from some of their accounts at your Post Office® branch.
The other advantages of having your money paid into an account are:
- you can get your money from many different places
- from some accounts you could have regular bills paid. This could save you money but you will need to make sure that there is enough money in your account to pay the bills. If not, you may be charged a fee
- using an account may help you save.
The account can be:
- in your name, or
- in the name of your partner. We use partner to mean a person you are married to or a person you live with as if you were married to them, or a civil partner or a person you live with as if you are civil partners, or
- in the names of both yourself and your partner, or
- in the name of the person acting on your behalf, or
- in the names of both yourself and the person acting on your behalf.
Benefit is paid either every 4 weeks, every 13 weeks or every week.
If you have a bank or building society account but you do not wish to use it, for example a joint account, any bank or building society will help you open an account that suits you better. Remember to ask whether their accounts allow you to get your money from the Post Office®, if this is important to you.
Basic bank account
If you have had problems opening a current account, or if you are worried about being overdrawn, you could ask any bank or building society about opening a basic bank account.
These are sometimes called introductory or starter accounts and are available from all major banks.
These accounts offer free banking but overdrafts are not available.
You can use these accounts to pay money in, pay bills automatically and get cash out.
Many basic bank accounts also allow you to get cash from Post Offices®.
If your circumstances change
A decision can be looked at again at any time if your condition has changed.
If you feel your condition has got worse and you want us to have another look at the decision, complete and return form BI168, which you can get from your Jobcentre Plus or social security office.
If the condition for which you are getting benefit improves you must tell us straight away.
If you are receiving Industrial Injuries Disablement Benefit you must also tell us if
- you marry, remarry, or form a civil partnership and change your name
- you change your address
- you leave the country
- you go into prison.
If any of these apply, you must tell your Regional Industrial Injuries Benefit Delivery Centre straight away. [Legislation (70)]
If you leave the country
If you leave the country, Industrial Injuries Disablement Benefit is payable while you are away. If you intend to be away for less than 3 months, and you are paid by order book, you should consider having your benefit paid directly into an account. For further details please read the ‘How you are paid Industrial Injuries Disablement Benefit’ paragraphs of this guide.
If you intend to be away for more than 3 months, payment of your benefit will be made by International Pensions Centre 3 (IPC3).
You will be asked how you want your payments to be made while you are away. You can choose between:
- Direct Payment to a United Kingdom (UK) bank, building society or Post Office® card account every 4 or 13 weeks
- payable orders sent directly to you every 4 or 13 weeks while you are away
- Transcontinental Automated Payments (TAPS), if the country has this arrangement with Jobcentre Plus
- payment to a nominee
- payment when you return to the UK.
You must let us know when you return to the UK.
If you go to prison
If you go into prison, you must let us know the date you were admitted.
Payment of Industrial Injuries Disablement Benefit is suspended during any period of imprisonment.
When you are released let us know the date. Arrears of Industrial Injuries Disablement Benefit may be paid for the period of imprisonment subject to a maximum of one year’s benefit.
If you die
If you die, someone should let us know straight away. If you have an order book, they should send it back straight away. They should not cash it.
Effects of Industrial Injuries Disablement Benefit on other benefits
Your basic Industrial Injuries Disablement Benefit does not affect any other National Insurance (NI) benefits such as:
- Incapacity Benefit
- Contribution-based Jobseeker’s Allowance
- Retirement Pension.
But Industrial Injuries Disablement Benefit may affect income-related benefits that you or your partner receive such as:
- Income Support
- Income-based Jobseeker’s Allowance
- Pension Credit
- Housing Benefit
- Council Tax Benefit
- Working Tax Credit
- Child Tax Credit.
Industrial Injuries Disablement Benefit may also affect how much War Pension you get, if you are entitled to both.
Constant Attendance Allowance
- Conditions of entitlement
- How and when to claim
- How claims are decided
- The decision on your claim
- How much benefit you will get
- How you are paid
- If your circumstances change
- Effects of CAA on other benefits
Conditions of entitlement
Constant Attendance Allowance (CAA) can be paid if you need constant care and attention as a result of your injury or disease. [Legislation (71)]
You can get CAA, for example, if you are bedridden, blind or paralysed. It is not paid for help with ordinary housework or for similar domestic purposes, and it is not paid simply for help with dressing and undressing.
If you apply for CAA, you have to prove that you need daily attendance and are likely to need it for a long time. Although you must show that you need daily attendance, the attendance need not last throughout the day.
Attendance need not be provided on a paid basis and CAA can still be paid when attendance is provided by a relative.
Industrial Injuries Disablement Benefit must be the 100% rate payable for you to be considered for CAA. [Legislation (72)]
But you may also receive it if you get Industrial Injuries Disablement Benefit of less than 100% and also receive payments for disablement which bring your total disablement to at least 100% under the:
- Workmen’s Compensation Acts
- or Pneumoconiosis, Byssinosis and Miscellaneous Diseases Benefit Scheme
- or War Pension scheme. [Legislation (73)]
How and when to claim
If Industrial Injuries Disablement Benefit is payable at the 100% rate, an opinion will automatically be given for CAA at the time of your medical examination.
You only need apply for CAA if you are already receiving benefit at the 100% rate and you later discover that you need constant attendance. You should then claim on form BI104 which you can get from your Regional Industrial Injuries Benefit Delivery Centre or on the DWP website. The addresss is www.dwp.gov.uk.
How claims are decided
Medical services carry out an examination at the same time as giving an opinion on the extent of your disablement. The doctor will complete a report and advise on your need for attendance. They will look at and consider:
- the nature and amount of attendance you need
- if you are dependent on attendance for the necessities of life
- if you need attendance as a result of the relevant loss of faculty.
There are four rates of CAA based on the amount of attendance you need.
These are:
- part-time
- or normal maximum
- or intermediate
- or exceptional. [Legislation (74)]
Before giving advice, it may be necessary to arrange a visit in your own home to see what your requirements are.
The report will give details of your home life including information about:
- what you can do for yourself
- what help you need during the day
- how you spend your time
- details of the amount and type of attendance you need at night and the length of time taken to provide it on each occasion
- reasons for any night attendance
- what aids are available and used for moving around or outside the home and travelling
- any special features incorporated in or added to the home.
The decision maker will consider the doctor’s report and any other evidence and will decide the rate, amount and period of the award. The award will be renewed if you continue to satisfy the conditions.
The decision on your claim
You will be notified of the decision in writing. It will explain how the decision was arrived at and if there is any entitlement to benefit.
If you disagree with the decision
There is no right of appeal against a decision on CAA. If you disagree with the decision you can ask for it to be reconsidered if you consider you have good reason. [Legislation (75)]
See NI260 ‘DMA – A guide to Dispute, Supersession and Appeal’.
How much benefit you will get
How much benefit you get depends on how much looking after you need. Up to date amounts are in Social Security Benefit Rates (BRA5DWP)
How you are paid
Payment of your CAA will be made with your Industrial Injuries Disablement Benefit direct into an account.
If your circumstances change
If you are getting CAA you must tell us straight away if you are admitted to hospital or similar institution.
CAA is payable for the first 4 weeks of free in-patient treatment if:
- you are already receiving CAA at the date of admission
- or CAA is subsequently granted for a period which includes the date of admission.
If you are in hospital longer than 4 weeks and payment has stopped, you can receive payment for certain periods when you are allowed to leave hospital. Payment will start again when you are discharged.
If you go abroad, CAA can be paid for 6 months from the date you go, or for a longer period as the Secretary of State may allow. [Legislation (77)]
Effects of CAA on other benefits
If you qualify for CAA, you cannot also get Attendance Allowance (AA) or the care component of Disability Living Allowance (DLA), unless it is higher than the CAA. In that case you will get CAA and may get the balance of the other benefit.
While you are getting CAA, the person looking after you may be able to get Carer’s Allowance (CA) or may have their rights to basic National Insurance Retirement Pension protected without the need to pay voluntary contributions by applying for Home Responsibilities Protection (HRP).
CAA does not affect any other National Insurance benefits such as:
- Incapacity Benefit
- Contribution-based Jobseeker’s Allowance
- Retirement Pension.
But CAA may affect income-related benefits you or your partner receive such as:
- Income Support
- Income-based Jobseeker’s Allowance
- Pension Credit
- Housing Benefit
- Council Tax Benefit
- Working Tax Credit
- Child Tax Credit.
Exceptionally Severe Disablement Allowance
- How claims are decided
- The decision on your claim
- How you are paid
- If your circumstances change
- Effects on other benefits
This is an extra allowance if you are exceptionally severely disabled and already entitled to CAA at the intermediate or exceptional rate, and your need for the attendance is likely to be permanent. [Legislation (78)]
You do not have to make a separate claim. Your entitlement will be considered at the same time as your CAA.
How claims are decided
When CAA is granted at the intermediate or exceptional rate, entitlement to Exceptionally Severe Disablement Allowance is automatically considered at the same time.
The decision maker looks at the doctor’s advice and decides the period of the award. Exceptionally Severe Disablement Allowance is usually awarded for the same period as CAA. The allowance may be reconsidered from time to time depending on your circumstances.
The decision on your claim
You will be notified of the decision in writing. It will explain how the decision was arrived at and if there is any entitlement to benefit.
If you disagree with the decision
There is no right of appeal against a decision on Exceptionally Severe Disablement Allowance. If you disagree with the decision you can ask for it to be reconsidered if you think you have good reason. [Legislation (79)]
How you are paid
Payment of your Exceptionally Severe Disablement Allowance will be made with your Industrial Injuries Disablement Benefit and Constant Attendance Allowance direct into an account.
If your circumstances change
If you are absent abroad, Exceptionally Severe Disablement Allowance can be paid for 6 months from the date of absence from the United Kingdom, or for such longer period as the Secretary of State may allow. [Legislation (80)]
If you are admitted to hospital or a similar institution for medical treatment you can continue to receive Exceptionally Severe Disablement Allowance.
Effects on other benefits
Your Exceptionally Severe Disablement Allowance does not affect any other National Insurance benefits such as:
- Incapacity Benefit
- Contribution-based Jobseeker’s Allowance
- Retirement Pension.
But Exceptionally Severe Disablement Allowance may affect income-related benefits you or your partner receive such as:
- Income Support
- Income-based Jobseeker’s Allowance
- Pension Credit
- Housing Benefit
- Council Tax Benefit
- Working Tax Credit
- Child Tax Credit.
Reduced Earnings Allowance
- Conditions of entitlement
- How and when to claim
- How claims are decided
- The decision on your claim
- How much benefit you will get
- How you are paid
- If your circumstances change
- Effects of REA on other benefits
Conditions of entitlement
Reduced Earnings Allowance (REA) is a separate benefit to Industrial Injuries Disablement Benefit. It can be paid on its own or in addition to Industrial Injuries Disablement Benefit. REA was introduced from 1 October 1986 and replaced Special Hardship Allowance (SHA). [Legislation (81)]
REA can be paid on top of Industrial Injuries Disablement Benefit. If you do not get Industrial Injuries Disablement Benefit because your disablement is less than 14% you can still get REA as long as your disablement is assessed at 1% or more.
REA compensates for the loss of earnings’ capacity where, as a result of an industrial accident or disease, you are unable:
- either to return to your regular occupation
- or to carry out other work producing the same level of earnings.
There is no entitlement to REA for an accident which occurred on or after 1 October 1990. [Legislation (81)]
- or a prescribed disease with a date of onset on or after 1 October 1990
- or a prescribed disease which was added to the list of prescribed diseases on or after 10 October 1994 irrespective of the date of onset
- or an extension to a prescribed disease made on or after 10 October 1994 irrespective of the date of onset.
To be entitled to REA you must satisfy the following conditions:
- have an assessment of disablement of at least 1%
- be incapable of following your regular occupation as a result of the relevant loss of faculty
- be incapable of work of an equivalent standard which is considered suitable in your case and:
- either are likely to be permanently incapable of following your regular occupation (known as the permanent condition)
- or at all times since the end of the 90 day period (excluding Sundays) following the date of accident or date of onset of the prescribed disease, have been incapable of your regular occupation or suitable alternative employment (known as the continuous condition).
A regular occupation must be gainful employment, but it does not have to be employed earner‘s employment. This will occur when the work done at the time of the accident was employed earner‘s employment but it was not your regular occupation.
A regular occupation for a prescribed disease is normally the occupation which caused the disease.
Whether other employment is of an equivalent standard depends mainly on whether the pay is comparable. But your chances of promotion to higher paid work in your regular occupation can also be taken into account in some circumstances.
Only employed earner’s employment can be considered as employment of an equivalent standard. [Legislation (82)]
If you gave up an occupation because of the relevant loss of faculty due to the prescribed disease for which you have an assessment, that occupation can be your regular occupation even if you stopped following it before the prescribed disease was:
- added to the list of prescribed diseases
- altered to include your work.
Your occupation may be treated as your regular occupation if you:
- had to give up an occupation because of the effects of an industrial accident or prescribed disease
- and subsequently receive a disablement assessment for that accident or disease [Legislation (83)]
If you are suffering from pneumoconiosis and the doctor who examined you for Industrial Injuries Disablement Benefit purposes gave advice about the conditions in which you should work, there are rules which may help you qualify for REA if you leave your regular occupation. You will usually be regarded as unable to continue in that occupation or to do work of an equivalent standard. This will apply even if the doctor advised that you could continue in your occupation in suitable dust conditions.
If you have more than one accident or prescribed disease, you can claim REA for each accident or prescribed disease.
How and when to claim
Contact your local Jobcentre Plus office for a claim form BI103. You can get the address of your nearest office from the post office, or by looking in the business section of the phone book under Jobcentre Plus, or by using the local office search on the Jobcentre Plus website.
- You can also download form BI103 (239KB)
The date of your claim is the date your fully completed claim form is received by a Jobcentre Plus. It is very important that you carefully fill in all the details on the form and return it to your Regional Industrial Injuries Benefit Delivery Centre as soon as possible. [Legislation (84)]
Claim as soon as you think you meet the rules for the allowance. Do not delay claiming until the result of your Industrial Injuries Disablement Benefit claim is determined, as you could lose benefit for any period more than 3 months before the date of claim. [Legislation (85)]
If you want help filling in your claim form, or any part of it, ring the Benefit Enquiry Line for people with disabilities. The telephone number is 0800 88 22 00.
How claims are decided
When you have completed the claim form return it to your Jobcentre Plus.
Your papers are then sent to medical services for advice on whether:
- you are capable of following your regular occupation
- the date from which you are incapable of following your regular occupation
- you are temporarily or permanently incapable of following your regular occupation
- you are incapable of alternative remunerative employment
- if you are not completely incapable of work, what limitations, if any, exist which restrict the type of work you can do.
The decision maker will use this advice to determine whether or not you have any entitlement to REA.
The decision on your claim
We may contact your current or previous employers to obtain employment and earnings information about
- your regular occupation
- your present occupation
- any occupation you have had since your accident or disease.
If your regular occupation no longer exists, your earnings may be calculated by referring to an index based on the changes in the level of earnings as published in the Annual Survey of Hours and Earnings.
REA will be awarded for a limited period. At the end of this period, we will invite you to make a renewal REA claim unless your assessment of disablement was final and expires at the same time as the REA award.
We will send you a renewal form before your award ends. If you were entitled to REA on 30 September 1990 and you subsequently cease to be entitled for one or more days, you cannot again become entitled to REA for that accident or prescribed disease. You should complete and return the form as soon as possible to avoid any delays in payment or a possible permanent loss of your entitlement to REA. You must still complete a renewal form even if payment is temporarily suspended for any reason. The decision maker will decide:
- whether up-to-date medical advice is needed
- if further employment enquiries need to be made.
If you disagree with the decision
How much benefit you will get
The amount of REA payable is the difference between your earnings in your regular and alternative occupations. There is a maximum amount of REA payable, even if the difference in earnings between your regular and alternative occupation is greater than this amount.
This maximum is equivalent to the 40% rate of Industrial Injuries Disablement Benefit. [Legislation (86)]
If you receive more than one REA award, the maximum amount of REA and any Industrial Injuries Disablement Benefit you can receive equates to the 140% rate of Industrial Injuries Disablement Benefit.
You will be notified of the amount of benefit you are entitled to.
REA under the Industrial Injuries Scheme can be paid as well as an allowance for a lower standard of occupation under the War Pension scheme.
REA, like most social security benefits, goes up from time to time, but your REA will not be increased if before 9 April 1989 you:
- received REA
- and retired for social security purposes.
If you reach pension age now, your entitlement to REA is transferred to entitlement to Retirement Allowance if you are not in regular employment. [Legislation (87)
- See ‘Retirement Allowance’.
How you are paid
Our policy is to pay all benefits directly into an account.
This is the safest way to pay you and lets you choose how and when you get your money. You can use a bank or building society.
You may be able to use a cash machine, which will usually mean you can get your money at any time of the day or night.
There are arrangements with banks and building societies so that you can collect cash from some of their accounts at your Post Office® branch.
The Post Office® also provides a bank account that we can pay benefits into. With this account you can only collect your money in cash from Post Office® branches.
The other advantages of having your money paid into an account are:
- you can get your money from many different places
- from some accounts you could have regular bills paid. This could save you money but you will need to make sure that there is enough money in your account to pay the bills. If not, you may be charged a fee
- using an account may help you save.
The account can be:
- in your name, or
- in the name of your partner. We use partner to mean a person you are married to or a person you live with as if you were married to them, or a civil partner or a person you live with as if you are civil partners, or
- in the names of both yourself and your partner, or
- in the name of the person acting on your behalf, or
- in the names of both yourself and the person acting on your behalf.
Benefit is paid either every 4 weeks, every 13 weeks or every week.
If you have a bank or building society account but you do not wish to use it, for example a joint account, any bank or building society will help you open an account that suits you better. Remember to ask whether their accounts allow you to get your money from the Post Office®, if this is important to you.
Basic bank account
If you have had problems opening a current account, or if you are worried about being overdrawn, you could ask any bank or building society about opening a basic bank account.
These are sometimes called introductory or starter accounts and are available from all major banks.
These accounts offer free banking but overdrafts are not available.
You can use these accounts to pay money in, pay bills automatically and get cash out.
Many basic bank accounts also allow you to get cash from Post Offices®.
Post Office® card account
This is a simple bank account that can only have benefit/pension/allowance/credit payments paid into it.
You can only collect payment from it in cash at a Post Office® branch.
You will not have a cheque book and cannot withdraw money at a cash machine.
You will not be able to run up an overdraft, pay bills by Direct Debit or Standing Order, or have your salary or any other money paid in.
The account can only be in your name.
You may be able to arrange with the Post Office® for someone else to collect your benefit regularly from this account.
If your circumstances change
If:
- you stop or start working
- or your earnings alter
- or you change occupation
- or you are over pension age and stop working an average of ten hours a week
- or you stop or start getting Incapacity Benefit
you must tell your Regional Industrial Injuries Benefit Delivery Centre straight away, as your award may be affected.
You must also tell your Regional Industrial Injuries Benefit Delivery Centre straight away if:
- you marry, remarry or form a civil partnership and change your name
- you change your address
- you leave the country
- you go into prison.
If you leave the country
If you go abroad to a country where there is no reciprocal arrangement and the European Union (EU) regulations do not apply, REA can be paid for the first 3 months abroad if:
- your stay is temporary
- your stay is not for business purposes in any way
- the claim for REA was made before you went abroad.
To qualify for REA when you return to the UK, you must have had title to REA throughout your stay even if REA is not paid during part of the absence. If title to REA is not maintained you may not be able to receive REA again.
If you go to prison
If you are imprisoned you cannot get REA. You must tell your social security office when you are admitted and when you are released. [Legislation (89)]
If you die
If you die, someone should let us know straight away. If you have an order book, they should send it back straight away. They should not cash it.
Effects of REA on other benefits
Your REA does not affect any other National Insurance benefits such as:
- Employment and Support Allowance
- Contribution-based Jobseeker’s Allowance
- Retirement Pension.
But REA may affect income-related benefits you or your partner receive such as:
- Income Support
- Income-based Jobseeker’s Allowance
- Pension Credit
- Housing Benefit
- Council Tax Benefit
- Working Tax Credit
- Child Tax Credit.
Retirement Allowance
- Conditions of entitlement
- The decision on your claim
- How much benefit you will get
- How you are paid
- If your circumstances change
- Effects of Retirement Allowance on other benefits
Conditions of entitlement
Retirement Allowance (RA) replaces REA when you reach age 60 (woman) or 65 (man) if REA is at least £2.00 a week and you are not in regular employment. [Legislation (90)]
If REA is paid at less than £2.00 a week and you are not in regular employment when you reach age 60 (woman) or 65 (man) you will not be entitled to either REA or RA.
Regular employment means working under a contract of service for an average of 10 hours a week or more over a period of 5 consecutive weeks or more. [Legislation (91)]
If you are in regular employment when you reach age 60 (woman) or 65 (man), you will continue to receive REA for as long as you remain in regular employment. Once you stop regular employment your entitlement to REA will be replaced by entitlement to RA, provided that REA was payable at over £2.00 a week.
You do not need to claim RA. You will be sent a letter to complete before reaching age 60 (woman) or 65 (man).There will be a part of this you have to complete and return before a decision can be made. The letter will ask for details of your employment.
The decision on your claim
You will be notified of the decision in writing. It will explain the decision and if there is any benefit payable.
If you disagree with the decision
How much benefit you will get
RA is paid for life. [Legislation (92)]
The weekly rate of RA is whichever of the following is less (1/2p or more being rounded up):
- either 25% of the weekly rate of REA to which you were last entitled
- or 10% of the 100% Industrial Injuries Disablement Benefit pension rate. [Legislation (93)]
You can only get one award of RA, regardless of how many REA awards were in payment previously.
How you are paid
RA will be paid in the same way as your REA direct into an account.
It is paid either every week, every 4 weeks or every 13 weeks.
If you are receiving Industrial Injuries Disablement Benefit your RA will be paid together direct into the same account.
If your circumstances change
If you are imprisoned you cannot get RA. You must tell your Jobcentre Plus or social security office when you are admitted and return your order book if you are paid in this way. When you are released tell your Jobcentre Plus or social security office straight away so that payment can be considered again. [Legislation (94)]
If you are living abroad and have maintained underlying entitlement to REA whilst abroad, even though disqualified from receiving payment, you can be awarded and paid RA once you are over the minimum pension age and cease regular employment.
If you are entitled to RA and live, or go to live, in any country you will continue to receive RA for life. [Legislation (95)]
Effects of Retirement Allowance on other benefits
Your Retirement Allowance does not affect any other National Insurance benefits such as:
- Incapacity Benefit
- Contribution-based Jobseeker’s Allowance
- Retirement Pension.
But Retirement Allowance may affect income-related benefits you or your partner (We use partner to mean a person you are married to or a person you live with as if you were married to them, or a civil partner or a person you live with as if you are civil partners.) receive such as:
- Income Support
- Income-based Jobseeker’s Allowance
- Pension Credit
- Housing Benefit
- Council Tax Benefit
- Working Tax Credit
- Child Tax Credit.
Industrial Death Benefit
- Conditions of entitlement
- How you are paid
- If you disagree with the decision
- If your circumstances change
Conditions of entitlement
Industrial Death Benefit (IDB) is a benefit payable to the widow or widower and children of a person working as an employed earner who died as a result of an industrial accident or prescribed disease. The death must have been before 11 April 1988. [Legislation (96)]
For deaths before 11 April 1988, the widow is entitled to Industrial Death Benefit if when her husband died she was:
- residing with him
- or receiving from him directly, or through another person, periodical payments for her maintenance provided or procured by the deceased, amounting on average to not less than 25p per week [Legislation (97)]
- or entitled to payments such as those above under an order of court, a trust or an agreement, which she had taken reasonable steps to enforce. [Legislation (98)]
If the qualifying conditions are satisfied, the rate payable is decided on individual circumstances.The personal rates of benefit payable are:
- initial rate (first 26 weeks after death)
- higher permanent rate
- lower permanent rate. [Legislation (98)]
The widower is entitled to industrial Death Benefit if when his wife died he was:
- being wholly or mainly maintained by her or would have been if the relevant accident or disease had not happened, and
- permanently incapable of supporting himself. [Legislation (99)]
If the qualifying conditions are satisfied the rate payable is at the higher permanent level.
Additional entitlement
There may also be an entitlement to payment of
- Child Increase or Children Increases [Legislation (100)]
- Christmas Bonus [Legislation (101)]
- Age 80 addition. [Legislation (102)]
Entitlement to Industrial Death Benefit for a child is linked to both:
- the deceased’s entitlement to Child Benefit (CHB)
- and the entitlement of the person now claiming money for them. [Legislation (103)]
Industrial Death Benefit is taxable but increases of Industrial Death Benefit for children are not taxable.
How you are paid
Our policy is to pay all benefits directly into an account.
This is the safest way to pay you and lets you choose how and when you get your money. You can use a bank or building society.
You may be able to use a cash machine, which will usually mean you can get your money at any time of the day or night.
There are arrangements with banks and building societies so that you can collect cash from some of their accounts at your Post Office® branch.
The Post Office® also provides a bank account that we can pay benefits into.
With this account you can only collect your money in cash from Post Office® branches.
The other advantages of having your money paid into an account are:
- you can get your money from many different places
- from some accounts you could have regular bills paid. This could save you money but you will need to make sure that there is enough money in your account to pay the bills. If not, you may be charged a fee
- using an account may help you save.
The account can be:
- in your name, or
- in the name of the person acting on your behalf, or
- in the names of both yourself and the person acting on your behalf.
Benefit is paid either every 4 weeks, every 13 weeks or every week.
If you have a bank or building society account but you do not wish to use it, for example a joint account, any bank or building society will help you open an account that suits you better. Remember to ask whether their accounts allow you to get your money from the Post Office®, if this is important to you.
Basic bank account
If you have had problems openinga current account, or if you are worried about being overdrawn, you could ask any bank or building society about opening a basic bank account.
These are sometimes called introductory or starter accounts and are available from all major banks.
These accounts offer free banking but overdrafts are not available.
You can use these accounts to pay money in, pay bills automatically and get cash out.
Many basic bank accounts also allow you to get cash from Post Offices®.
Post Office® card account
This is a simple bank account that can only have benefit/pension/allowance/credit payments paid into it.
You can only collect payment from it in cash at a Post Office® branch.
You will not have a cheque book and cannot withdraw money at a cashmachine.
You will not be able to run up an overdraft, pay bills by Direct Debit or Standing Order, or have your salary or any other money paid in.
The account can only be in your name.
You may be able to arrange with the Post Office® for someone else to collect your benefit regularly from this account.
If you disagree with the decision
Although the NI260 DMA does not specifically mention Industrial Death Benefit, the generic procedures for dealing with disputes, supersessions and appeals apply.
If your circumstances change
Industrial Death Benefit for a widow is usually a pension payable for life following the deceased’s death. It is not payable:
- if you remarry or form a civil partnership [Legislation (104)]
- or for any period when you and a man you are not married to are living together as husband and wife [Legislation (105)]
- or if you are in prison. [Legislation (106)]
If any of the above apply you must tell the Industrial Death Benefit section at the Industrial Injuries Unit straight away.
Accidents and diseases before 5 July 1948 – Workmen’s Compensation (Supplementation) Scheme
- Conditions of entitlement
- How and when to claim
- The decision on your claim
- How you are paid
- If your circumstances change
- Other benefits you may be entitled to
You may be able to get benefit under this scheme if you are already getting Workmen’s Compensation for an accident or disease from work you did before 5 July 1948, or think you have a right to this. [Legislation (108)]
The Department for Work and Pensions (DWP) does not pay Workmen’s Compensation. It is paid by your employer.
You and your employer have to settle the compensation in the way laid down by the Workmen’s Compensation Acts. This is by agreement with the employer or, if you cannot reach agreement, by arbitration and then by the courts.
This extra benefit is called Workmen’s Compensation (Supplementation). It can only be paid if you live in the UK, another European country or in a country with which Great Britain has an agreement covering industrial injuries.
Conditions of entitlement
There are three main allowances:
- basic allowance
- major incapacity allowance
- lesser incapacity allowance.
Basic allowance
The basic allowance of up to £2 a week is applicable if you had an accident or contracted a disease in your job before 1 January 1924 and, as result, are totally or partially unable to work. You must have had a right on or after 21 March 1951 to weekly payments under the Workmen’s Compensation Act, or payments under any employer’s contracting-out scheme. [Legislation (109)]
Major incapacity allowance
You can get a major incapacity allowance if one of the conditions in the left-hand column and one of the conditions in the right-hand column apply:
|
|
|
| or | were paid a basic allowance any time after 5 July 1956 |
|
| or | had a lump sum settlement before 5 July 1956 and have since had the right to weekly payments that can be treated as Workmen’s Compensation. |
|
|
||
The major incapacity allowance normally makes up the weekly compensation and basic allowance to the same rate as the 100% Industrial Injuries Disablement Benefit.
If you do not meet these basic rules now, you may be able to get the lesser incapacity allowance.
Lesser incapacity allowance
If you are partially unable to work because of an accident or disease from your work before 5 July 1948 you can claim a lesser incapacity allowance, providing:
- you have had a right to weekly basic allowance or Workmen’s Compensation for loss of earnings at some time after 1 March 1966
- or you would have had a right but the employer is paying you an incapacity pension or some other payment which is regarded as Workmen’s Compensation. Payments from an employer instead of a formal declaration of liability do not meet this condition. If the weekly payment is now less than 2.5 pence (or less than 6d (2.5 pence) before 30 November 1965) you will have to prove that it is based on loss of earnings calculated under Workmen’s Compensation rules.
The weekly rate of your lesser incapacity allowance is based on the earnings you are losing because of your injury or disease. This is decided by comparing what you earn with the earnings of people in your pre-accident occupation.
But if the job you were doing does not exist now, a similar job with the same earning power today is used instead. Any reasonable prospects of advancement which you may have lost may be taken into account. [Legislation (110)]
How and when to claim
- For a claim form write to or phone the Industrial Injuries Unit Pneumoconiosis and Workmen’s Compensation Section.
Send your completed claim form to this address also.
Do not delay claiming because benefit cannot be paid for a period more than 3 months before the date of your claim.
When we receive your claim we will send you an acknowledgement. [Legislation (111)]
The decision on your claim
If you satisfy the residence and entitlement conditions we then make enquires about loss of earnings and obtain medical evidence.
When we have all the information we need your claim will be decided by a decision maker. The decision maker will look at the medical evidence and any other available evidence.
We will write to tell you the decision on your claim, the amount of any benefit you will get (current rates can be found in Social Security Benefit Rates (BRA5DWP)) and the period for which you will get benefit.
If you disagree with the decision
See NI260 DMA – ‘A guide to Dispute, Supersession and Appeal’.
Although the NI260 DMA does not specifically mention WC(Supp), the generic procedures for dealing with disputes, supersessions and appeals apply.
How you are paid
Our policy is to pay all benefits directly into an account.
This is the safest way to pay you and lets you choose how and when you get your money. You can use a bank or building society.
You may be able to use a cash machine, which will usually mean you can get your money at any time of the day or night.
There are arrangements with banks and building societies so that you can collect cash from some of their accounts at your Post Office® branch.
The Post Office® also provides a bank account that we can pay benefits into.
With this account you can only collect your money in cash from Post Office® branches.
The other advantages of having your money paid into an account are:
- you can get your money from many different places
- from some accounts you could have regular bills paid. This could save you money but you will need to make sure that there is enough money in your account to pay the bills. If not, you may be charged a fee
- using an account may help you save.
The account can be:
- in your name, or
- in the name of your partner. We use partner to mean a person you are married to or a person you live with as if you were married to them, or a civil partner or a person you live with as if you are civil partners, or
- in the names of both yourself and your partner, or
- in the name of the person acting on your behalf, or
- in the names of both yourself and the person acting on your behalf.
Benefit is paid either every 4 weeks, every 13 weeks or every week.
If you have a bank or building society account but you do not wish to use it, for example a joint account, any bank or building society will help you open an account that suits you better. Remember to ask whether their accounts allow you to get your money from the Post Office®, if this is important to you.
Basic bank account
If you have had problems opening a current account, or if you are worried about being overdrawn, you could ask any bank or building society about opening a basic bank account.
These are sometimes called introductory or starter accounts and are available from all major banks.
These accounts offer free banking but overdrafts are not available.
You can use these accounts to pay money in, pay bills automatically and get cash out.
Many basic bank accounts also allow you to get cash from Post Offices®.
Post Office® card account
This is a simple bank account that can only have benefit/pension/allowance/credit payments paid into it.
You can only collect payment from it in cash at a Post Office® branch.
You will not have a cheque book and cannot withdraw money at a cash machine.
You will not be able to run up an overdraft, pay bills by Direct Debit or Standing Order, or have your salary or any other money paid in.
The account can only be in your name.
You may be able to arrange with the Post Office® for someone else to collect your benefit regularly from this account.
If your circumstances change
A decision can be looked at again at any time if your condition has changed.
If you feel your condition has got worse and you want us to have another look at the decision, write to or phone the Industrial Injuries Unit Pneumoconiosis and Workmen’s Compensation Section.
If the condition for which you are getting benefit improves you must tell us straight away.
You must also tell us if you:
- marry, remarry or form a civil partnership and change your name
- change your address
- leave the country
- go into prison
- go into hospital or similar accommodation.
If any of these apply, you must tell the Industrial Injuries Unit Pneumoconiosis and Workmen’s Compensation Section straight away. [Legislation (113)]
If you die, someone should let us know straight away. If you have an order book, they should send it back straight away. They should not cash it.
Other benefits you may be entitled to
Constant Attendance Allowance
You may be entitled to Constant Attendance Allowance if the need for constant attendance is because of the injury or disease for which compensation is or was payable.
Four primary conditions must all be met before Constant Attendance Allowance can be awarded. You must be:
- entitled to weekly payments of Workmen’s Compensation on or after 5 July 1948 and totally incapable of work and likely to remain so
- and dependent on attendance for the necessities of life
- and able to demonstrate that the attendance is needed as a result of the relevant loss of faculty
- and able to demonstrate that attendance will be needed for a prolonged period.
- See ‘Constant Attendance Allowance’ for general information on Constant Attendance Allowance.
Exceptionally Severe Disablement Allowance
To qualify for Exceptionally Severe Disablement Allowance you must:
- have an award of Constant Attendance Allowance at either the intermediate or exceptional rate
- and be likely to need that level of attendance permanently. [Legislation (114)]
- See ‘Exceptionally Severe Disablement Allowance’ for general information on Exceptionally Severe Disablement Allowance.