See also: Benefit Rates
Reassessment of claims:
People who receive Incapacity Benefit, on the grounds of illness or disability will be assessed for Employment and Support Allowance.
People who are capable of work will move onto Jobseeker’s Allowance where they satisfy the conditions of entitlement for that benefit.
People who need more support while they prepare for work will get that help on Employment and Support Allowance (ESA).
Those people who are most disabled or terminally ill will not be expected to look for work and will get the extra support they need on ESA.
Incapacity Benefit is for people unable to work because
of illness or a disability. It is paid if Statutory Sick Pay
(SSP) has ended, or if you cannot get SSP (SSP is paid for the
first 28 weeks of sickness). IB is not paid if you were already
over state pension age when you became sick.
You must have paid enough National Insurance contributions to qualify.
It is not means-tested, so the amount you receive does not depend on your income or savings. However, if you make a new claim to IB for a date on or after 6th April 2001, you will have any gross Pension Income taken into account when the payable rate of benefit is being calculated.
Incapacity Benefit replaced Invalidity and Sickness Benefit from 13 April 1995. People getting Invalidity Benefit (IVB) or Sickness Benefit at the time of the changeover were automatically transferred onto Incapacity Benefit and the amount of benefit, they were receiving at the time was not affected.
You qualify for short-term Incapacity Benefit if you:
have paid National Insurance contributions and
you are 'incapable of work' or are in a 'period of incapacity for work'.
If you have been incapable of work because of sickness or disability for at least 4 days in a row including weekends and Bank Holidays, and
cannot get statutory sick pay
you are under state pension age (65) or
you are no more than 5 years over state pension age, your 'period of incapacity for work' began before pension age, and you would be entitled to retirement pension if you claimed it.
If you are aged under 20 you may be able to get IB even if you have not paid enough National Insurance contributions, provided you have been sick for at least 28 weeks without a break.
The same applies if you are aged 20 or over but under 25, and you were in education or training for at least 3 months before your 20th birthday.
There are several different rates of IB
For the first 28 weeks of incapacity you can get the short-term
lower rate. After 28 weeks on the lower rate, you move onto
the short-term higher rate. This is paid from week 29 to week
52. After 52 weeks, the long-term rate becomes payable.
Short-term IB at the lower rate will be paid if
you do not get SSP and have been sick for at least 4 days in a row including weekends and bank holidays, or if you qualify under the special rules for young people.
Short-term IB at the higher rate will be paid if
you have been sick for more than 28 weeks and less than 52 weeks. If you qualify under the special rules for young people you must have been getting lower rate IB for 28 weeks.
Long-term IB will be paid if
you have been sick for more than 52 weeks. If you qualify under the special rules for young people, you must have been getting short-term IB for 52 weeks.
If you get the highest rate care component of Disability Living Allowance (DLA) or you are terminally ill, you will get IB paid at the long-term rate after you have been sick for 28 weeks.
If you qualify under the special rules for young people and you get the highest rate care component of DLA or you are terminally ill, you will get IB paid at the long-term rate after you have been getting IB for 28 weeks.
See: Benefit Rates
If you are under 20 (25 if you have been in education or training)
you may be able to get IB even if you have not paid NI contributions.
If you have recently come from abroad, or returned from abroad, there are some extra rules. You may be treated as having paid the necessary National Insurance contributions to get IB if you have:
Been working abroad for an employer based in the United Kingdom and paid NI contributions for the first 52 weeks of that employment, or
Paid enough UK NI contributions and the equivalent of NI contributions in certain other countries.
If you became sick before reaching pension age, you may be able to get IB after pension age. It can be paid at the Retirement Pension rate for up to one year of sickness.
If you get the long-term rate of IB you may qualify for extra money depending on your age when you became sick. You may get Incapacity Age Addition if you get long-term IB and were aged under 45 on the day you became unable to work. This includes days you got Statutory Sick Pay.
For new claims, half of your occupational or personal pension(s) above £85 is to be deducted from your incapacity benefit. For example, if you have a weekly occupational pension of £95 then your incapacity benefit will be reduced by £5 a week.
It is intended that permanent health insurance payments arranged through your employer will also be taken into account after your employment has ended.
The government has said you will be exempt if:
You already get incapacity benefit at the time the rules change - see below;
Your claim links back to an earlier incapacity benefit award that ended before the rules changed (contact the Benefits Agency to learn about the special linking rules for work and training;
You get disability living allowance higher rate care component;
The pension payments are in connection with the death of a member of the scheme.
It is expected that the rules will treat you as having an income
from an occupational pension that would be available to you if
you applied for it. So you can avoid the reduction by deferring
part of your pension. But this wil not pply to personal pensions
unless you are aged 60 or over
You claim using the Incapacity Benefit claim pack, SC1, available
A doctor's surgery
Department of Social Security (DSS)
You should send this form to your local DSS office after 4 days of sickness. For the first seven days you do not need a medical certificate. If you are incapable of work for more than seven days, you must also send a medical certificate (form Med 3) from your doctor. If you have worked in the same job for at least eight of the last twenty six weeks, for the first 28 weeks of your incapacity for work you will be assessed under the 'Own Occupation Test'.
If you have not worked recently, or after you have been incapable of work for 28 weeks you will have to go through the personal capability assessment. This tests your ability to do any kind of work. If you score enough points on this test you will be accepted as incapable of work.
The Benefits Agency will write to your GP for information about your mental health problem. On the basis of the letter, the Benefits Agency will decide whether your mental health problem is severe or less severe.
If they decide that you have a severe mental health problem, you will be awarded Incapacity Benefit.
If they decide that you have a less severe mental health problem, you will be sent a questionnaire, which asks you what physical problems you have.
If you have a mental health problem, you will need to write about your health problems in the special section (self-assessment questionnaire) on the claim form. You will be asked to attend a medical examination by a Benefits Agency Doctor, so that an additional mental health assessment can be carried out.
Backdating claims - You can send in your claim form up to three months after the first day for which you wish to claim. Ask your doctor for a backdated medical certificate, form Med 5. Your claim cannot be backdated for longer than this.
Your 'incapacity for work' must be 'by reason of some specific
disease or bodily or mental disablement'. There are two tests
the 'own occupation' test which looks at your ability to do your usual job if you've worked recently.
the personal capability assessment, which assesses your capacity to do any work. The test looks at your ability to carry out a range of activities such as working, standing, and sitting, and includes an assessment of mental health where appropriate.
When does the 'own occupation test' apply?:
If you have worked in one occupation for more than 8 weeks
out of the last 21 weeks before the first day for which a decision
on incapacity needs to be made. The work you do must be for at
least 16 hours per week. The 8 weeks do not need to be consecutive.
You can be employed or self-employed provided you are paid or
the work is done in expectation of payment. If you make a fresh
claim for benefit before the 196 days are up, and the break between
claims is less than 8 weeks, the own occupation test will continue
to apply for the remainder of the linked spell of 196 days.
If the 'own occupation test' does not apply i.e. you have not
worked for more than 8 weeks in the last 21 weeks; the personal
capability assessment applies from the first day of incapacity
for which you claim. This assessment will also be applied after
28 weeks (196 days) of Incapacity Benefit. Until you are assessed
under the personal capability assessment, you must continue to
send in medical certificates.
You cannot get Incapacity Benefit as well as Retirement Pension or Jobseeker's Allowance. Other benefits such as maternity allowance, severe Disablement Allowance, Invalid Care Allowance and Unemployment supplements are known as overlapping benefits. You can receive an amount equal to the highest of these benefits.
Other benefits that can be paid on top include:
Disability Living Allowance
If you were claiming Income Support, Housing Benefit or Council Tax Benefit because of incapacity, you will continue to get the disability premium paid with these benefits for as long as you remain incapable of working.
Incapacity Benefit is not means-tested so it is not affected if you receive
wages or an occupational pension or sick pay while you are off sick.
Generally if you do any work you are treated as capable of work and thus cannot get Incapacity Benefit.
But you are allowed to do some kinds of work and still receive Incapacity Benefit or Severe Disablement Allowance, or still be counted as incapable of work for other purposes e.g. Disability Premium. An Adjudication Officer at the Department of Social Security (DSS) makes the decision on whether or not the work you do is allowed.
From 8 April 2002 there are new rules if you want to try some
paid work while getting Incapacity Benefit, Severe Disablement
Allowance, National Insurance Credits or Income Support because
of illness or disability. The new rules are called the permitted
work rules and the work is called permitted work.
If you were already doing therapeutic work when the rules changed, you may be able to carry on doing it until April 2003. After that you can consider doing permitted work straight away under the new rules.
The new arrangements allow you to try some paid work without the need for prior approval from a doctor, but you should tell the office that pays your benefit before you start work.
You can work:
for earnings of up to and including £20.00 a week for an unlimited period, or
for less than 16 hours a week, on average, with earnings up to and including £67.50 a week for a 26 week period. The period can be extended for another 26 weeks if a Job Broker, Personal Adviser or Disability Employment Adviser agrees that it will help you towards work of 16 or more hours a week. There is no limit to the number of times you can do permitted work in this category while you are getting incapacity benefit; but there must be a gap of at least 52 weeks between periods. These subsequent periods are for 52 weeks and a Job Broker, Personal Adviser or Disability Employment Adviser must support the work from the outset.
in supported permitted work for earnings of up to and including £67.50 a week for an unlimited period.
Supported permitted work is work done with the ongoing support or supervision from a professional caseworker (employed or engaged by a public body or voluntary organisation). This could be work done in the community or in a sheltered workshop. It also includes work done under medical supervision as part of a hospital treatment programme.
You do not have to undergo a medical test just because you are doing permitted work. However, if a medical test is due it will go ahead as planned.
You can carry on getting Incapacity Benefit or Severe Disablement Allowance while doing permitted work without it affecting your benefit. If you get Income Support, Housing Benefit or Council Tax Benefit your benefit will be reduced if your average earnings are more than your earnings disregard.
You can do as much voluntary work as you like. Your Incapacity
Benefit will not be affected as long as you do not receive any
pay other than expenses.
The voluntary work must not be for a close relative.
You must tell your social security office if you do any voluntary work, and if you are paid in any way.
Permitted expenses could include:
Childminding or the costs of caring for another dependent
Equipment needed for work
Use of a telephone
There are transitional rules that protect the amount of benefit
you get if you transferred to Incapacity Benefit from invalidity
benefit and sickness benefit.
But you must pass the personal capability assessment unless you are exempt.
Transferred from Invalidity Benefit?
If you were entitled to Invalidity Benefit on 12.04.95, your benefit automatically became a 'transitional award of long-term Incapacity Benefit.' If your invalidity benefit stopped at any time between 15.02.95 and 12.04.95 and you became incapable of work again no more than 8 weeks after your last day of incapacity in that period, your new award is also a transitional award of long-term Incapacity Benefit.
Transferred from Sickness Benefit?
If you were entitled to sickness benefit on 12.04.95, your award automatically became a 'transitional award of short-term Incapacity Benefit', paid at the same rate as ordinary short-term Incapacity Benefit.
A transitional award ends when you move onto a long-term benefit. If you are getting sickness benefit because of an industrial accident or disease you can move on to long term Incapacity Benefit even if you don't satisfy the contribution conditions.
There are linking rules which theoretically help people to
restart benefits without losing out after a trial period at work.
This means that if you are off work because of illness or disability within 8 weeks of the end of your last incapacity benefit payment, the two periods of incapacity for work can sometimes be linked together to form a single period, and you will go back onto the benefit at the same rate and same terms as before. Ask for advice about this before starting work to find out how you can protect your rights; in practice these rules have been found to be problematic.
8 week linking rule
If you are off work because of illness or disability within 8 weeks of the end of your last incapacity benefit award, you'll go back on to benefit at the same rate on the same terms as before. This is because you are still in the same 'period of incapacity for work'.
52 week linking rule
This linking rule means that, if you have received benefit due to your incapacity for work, you can try out work or training for up to a year but later return to your previous level of benefit. This linking rule applies to claimants who reclaim the benefit within 52 weeks of leaving it for work or training. To quality for the 52 week protection you must:
have been incapable of work for more than 196 days (gaps of up to 8 weeks are ignored)
start work or training within one week of entitlement to the incapacity for work benefit ending
notify the Benefits Agency within one month of benefit stopping that you have started work or training (even if you have already informed them) and that you want to apply for the 52 week rule.~
Long-term Incapacity Benefit
If you over pension age (60 for women, 65 for men), you cannot normally receive long-term Incapacity Benefit. You can only receive long-term Incapacity Benefit after pension age if:
you are entitled to a transitional award because you were previously entitled to invalidity benefit and
you reached pension age before 13.04.95
Short-term Incapacity Benefit
You can make a claim for short-term Incapacity Benefit up to five years beyond pension age if you are in a 'period of incapacity for work', which begun before you reached pension age. (A 'period of incapacity for work' is made up of 4 or more consecutive days of incapacity). Or you can stay on short-term benefit beyond pension age rather than draw your pension if you choose.
Points to note:
You cannot get Incapacity Benefit and retirement pension at the same time, so you will not get short-term benefit if you draw your pension.
You don't have to satisfy the National Insurance contribution conditions for Incapacity Benefit once you reach pension age.
Incapacity Benefit is usually paid fortnightly in arrears.
The DSS can consider weekly payment if fortnightly payments are
causing hardship. If you get a transitional award, benefit is
still paid weekly in arrears as before. You may be paid by an
order book, by direct credit transfer into a bank or building
society, or by giro bank cheque.
Reviews and Appeals:
An Adjudication Officer at the DSS makes the decision on your
claim. If you disagree with the decision, you have the right
of appeal to an independent tribunal - Social Security Appeal
Tribunal - within 3 months of the decision being sent to you.
If you don't agree that you are fit for work it is well worth
appealing. While you are appealing, you can 'sign on' as available
for work for Jobseekers Allowance. This does not prejudice your
chance of winning an appeal on incapacity for work. By 'signing
on' you will protect your right to National Insurance credits,
whether or not your appeal is successful.
Welfare Benefits Handbook, published by Child Poverty Action
Group, 94 White Lion Street, London, N1 9PF.
Benefits and Mental Health: a guide to the benefits you can claim if you have a mental health problem. Alban Hawsworth, Disability Alliance, February 2001.
Disability Rights Handbook, available from Disability Alliance, 1st Floor East, Universal House, 88-94 Wentworth Street, London E1 7SA.
Rights Advice Line: 020 7247 8763 (minicom available)
DSS Leaflet IB201, Incapacity Benefit, order by telephone on 0800 868 686
Mental Health and Incapacity for Work: an information pack for people claiming Incapacity Benefit, Income Support and Sever Disablement Allowance available from the Department of Social Policy and Social Work, the University of Birmingham, Birmingham B15 2TT.
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