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LOCAL INFORMATION

9.8.8.L1
Incapacity Benefits

Extent: Jersey

Updated 20 December 2018
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Incapacity benefit

 

Incapacity benefit consists of three separate benefits:-

 

  1. Short Term Incapacity Allowance. See para 4
  2. Long Term Incapacity Allowance. See para 25
  3. Incapacity Pension. See para 43

 

These benefits may be payable when a person is incapable of work due to illness or injury or where there is a loss of faculty as a result of illness or injury.

Medical evidence is required to support each claim and certain contribution conditions must be satisfied for benefit to be paid.

Short Term Incapacity Allowance (STIA)

Short Term Incapacity Allowance is a daily benefit which may be payable when a medical certificate is submitted stating a person is unfit for work due to sickness or injury.

 

People in receipt of Short Term Incapacity Allowance must not work, even in a voluntary or honorary capacity whilst claiming this benefit as it is a replacement of earnings. Furthermore, they must not behave in a way which might delay their recovery.

 

Short Term Incapacity Allowance is payable for a minimum of two days and a maximum of 364 days. When the claim to Short Term Incapacity Allowance stops they may be able to claim Long Term Incapacity Allowance, see para 25.

Contribution conditions for the payment of Short Term Incapacity Allowance

To receive Short Term Incapacity Allowance two contribution conditions must be met.

 

First - Sufficient contributions must have been paid for at least three months at any time before the end of the relevant quarter, see para 12.

 

Second - To receive the full rate of benefit the claimant must have paid (or have been credited with) sufficient contributions for each of the months in the relevant quarter. Sufficient contributions mean their earnings must have been more than the lower threshold level for a particular month. If the claimant is a Class 2 Contributor they must have paid contributions at the required level. The amount of the lower threshold level changes each January, see 9.8.0.L4.

 

they will receive a reduced rate benefit if they meets the first condition and if they has paid enough contributions for at least one month in the relevant quarter. Benefit can not be paid if they has not paid enough contributions in any of the months in the relevant quarter. However they should send in the certificate even if they is not entitled to the allowance as they may be entitled to contribution credits.

 

Please note: If any of the necessary contributions have been paid late they may lose benefit. There are special rules to help a woman to qualify for benefit where her marriage has ended in divorce.

 

Jersey has agreements with several countries. If the claimant has recently arrived from any of these countries the payments they made there may be counted towards the contributions conditions for benefit in Jersey.

How to establish the relevant quarter for Short Term Incapacity Allowance

 

If Short Term Incapacity Allowance begins at some time in the quarter: The relevant quarter that affects payment of benefit is:
January - March July - September in the previous year
April - June October - December in the previous year
July - September January - March in the same year
October - December April -June in the same year

 

Rates of benefit paid for Short Term Incapacity Allowance

The standard weekly rate of benefit can be found at 9.0.0.L2. The rate is reviewed on 1 October every year and increases in line with the Jersey Earnings Index for the 12 months ending on 30 June of the same year.

How to claim Short Term Incapacity Allowance

When a person is unfit for work because of an illness or injury they should:-

 

  • Ask their doctor or the hospital for a medical certificate.
  • Fill in the certificate carefully to avoid any unnecessary delay in the processing of their claim.
  • Send the completed certificate to the Customer and Local Services within 30 days of the date they became incapable of work, otherwise they may lose benefit.

 

The first certificate in their claim to benefit must not cover a period of more than 28 days. their doctor may issue further certificates for a maximum of 13 weeks if they thinks the incapacity may be prolonged.

How Short Term Incapacity Allowance is paid

The benefit will usually be paid weekly in arrears. The claimant will receive a cheque which can be cashed at any Post Office or it can be paid into their bank account. They should contact Customer and Local Services if they is unable to sign the cheque so that arrangements can be made for someone of their choice to cash the cheques on their behalf. The post office will require the claimant to produce identification e.g. passport, driving licence or health card and proof of address, such as a utility bill.

Claiming an increase for a spouse or partner

It is possible to claim an increase in benefit if the claimant's spouse or partner is claiming Home Responsibility Protection and:-

 

 

  • is residing with them or
  • is mainly maintained by them.

See 9.8.0.L5

 

This increase may be reduced if their spouse or partner is receiving another benefit in their own right.

Other benefits payable whilst claiming Short Term Incapacity Allowance

Two payments from Social Security Funds cannot always be made for the same period. For example, Survivor's Pension would not be payable at the same time as Short Term Incapacity Allowance. It is also important to tell Customer and Local Services if they are receiving any other benefits from another country when they complete their medical certificate.

Changes in circumstances

The claimant must tell Customer and Local Services:-

 

 

  • If there are any changes in their circumstances that would affect the payment of benefit in respect of their wife or partner.
  • If they changes address so that they can continue to receive the payment on time.
  • In advance if they plans to leave Jersey (even if temporarily) indicating the country they intends to visit and the dates they intends to remain there. they may be able to receive Short Term Incapacity Allowance if they is resident in a country which is party to a reciprocal agreement with Jersey that covers this benefit.
  • If they are detained in prison as the benefit cannot be paid for any part of a prison sentence.
  • If they intends to do any work, even in a voluntary capacity.
  • If they has recently arrived in or returned to the Island. Reciprocal Agreements exist between many countries and Jersey so if they has not paid sufficient contributions in Jersey to qualify for Short Term Incapacity Allowance it may be possible to use the contributions they paid to another country to satisfy the contribution conditions for the allowance to be paid.

Contribution Credits whilst claiming Short Term Incapacity Allowance

A credit may be awarded for each day that the claimant is receiving Short Term Incapacity Allowance. The purpose of credits is to protect their contribution record for any future claims to Incapacity Benefit. They also protect their entitlement to pension. they will not be awarded credits if they has elected not to pay contributions.

The decision on a claim for Short Term Incapacity Allowance

In line with Social Security's procedures for monitoring claims to Incapacity Benefit they may be required to attend a Medical Board for examination by an independent doctor. If they fails to attend, without a valid reason, or if they refuses to be examined, they may be disqualified from receiving benefit for up to six weeks.

 

Claims are decided by a Determining Officer at Customer and Local Services. If the claimant is dissatisfied with the decision on their claim they may appeal to the Social Security Tribunal.

 

Please note: they must lodge their appeal within 28 days of the date of the disallowance notice.

Long Term Incapacity Allowance (LTIA)

Long Term Incapacity Allowance is a weekly benefit, payable as a compensation for a loss of faculty. The recipient may undertake paid or voluntary work whilst receiving this allowance.

Contribution conditions for the payment of Long Term Incapacity Allowance

To receive Long Term Incapacity Allowance two contribution conditions must be met.

 

First - they must have paid sufficient contributions for at least six months at any time before the end of the relevant quarter.

 

Second - they must have paid (or have been credited) sufficient contributions in the relevant quarter. Sufficient contributions means their earnings must have been more than the lower threshold level for a particular month. If they is a Class 2 Contributor they must have paid contributions at the required level. The amount of the lower threshold level changes each January, see 9.8.0.L4. If any of the necessary contributions have been paid late they will not be entitled to Long Term Incapacity Allowance.

How to establish the relevant quarter for Long Term Incapacity Allowance

 

    1. If Long Term Incapacity Allowance claim is received at Customer and Local Services during the quarter: The relevant quarter that affects payment of benefit is:
      January - March July - September in the previous year
      April - June October - December in the previous year
      July - September January - March in the same year
      October - December April -June in the same year

       

       

Jersey has Social Security agreements with several countries. If they has recently arrived from any of these countries the payments /she made there may be counted towards the contribution conditions for benefit in Jersey.

Rates of benefit paid for Long Term Incapacity Allowance

The standard weekly rate of benefit can be found at 9.0.0.L2. The rate is reviewed on 1 October every year and increases in line with the Jersey Earnings Index for the 12 months ending on 30 June of the same year.

 

Long Term Incapacity Allowance is always assessed as a percentage of the standard rate based on the claimant's loss of faculty. This percentage is decided by the Social Security Medical Board. To qualify they must have an assessment of at least 5%. An assessment of between 5% and 15% inclusive would be paid as a lump sum. The Medical Board will not tell the claimant the percentage of their assessment when they attends. they will be advised in writing within a few days.

How to claim Long Term Incapacity Allowance

If they has claimed Short Term Incapacity Allowance for the maximum 364 days they will then be sent a form on which to claim Long Term Incapacity Allowance. However, if they has some loss of faculty but return to work or their doctor does not consider that they is totally incapable for work they may obtain a claim form from Social Security. they does not need to send in medical certificates to claim Long Term Incapacity Allowance.

 

The claim form should be filled in carefully to avoid any unnecessary delay in the processing of the claim. The completed form should be sent to Customer and Local Services immediately to avoid loss of benefit.

 

The claimant will be asked to attend a Medical Board which usually consists of two doctors. they may submit to the Medical Board any evidence in support of their claim. their doctor will be told that they is attending a Medical Board and asked to submit relevant information.

Medical Board assessment

The Medical Board will assess the percentage of their loss of faculty within the agreed guidelines. If they is entitled to more than one separate claim to Long Term Incapacity Allowance the percentages are added together but to a maximum of 100%. An initial assessment will usually be provisional ie for a limited period. Subsequent assessments may be final indicating a permanent loss of faculty. Long Term Incapacity Allowance may continue to be paid until pension age.

How Long Term Incapacity Allowance is paid

Long Term Incapacity Allowance is paid on a Thursday, four weekly in advance. The payment will be made directly to their bank account.

Other benefits payable whilst claiming Long Term Incapacity Allowance

Two payments from Social Security Funds cannot always be made for the same period. It is important to tell Social Security if they is receiving Social Security benefits from any other country when they completes the claim form. If they is receiving Long Term Incapacity Allowance which is less than the standard rate the amount would be adjusted. Further information is available from Customer and Local Services.

Claiming an increase of benefit for your Spouse or Partner

they can claim an increase in their benefit if their spouse or partner is claiming Home Responsibility Protection and:-

 

 

  • is residing with their or
  • is mainly maintained by their.

See 9.8.0.L5

Changes in circumstances

The claimant must tell Social Security;-

 

 

  • if they changes address or bank account so that they can continue to receive their benefit
  • in advance if they plans to leave Jersey, indicating the country they intends to visit. they can receive Long Term Incapacity Allowance whilst residing outside Jersey for a maximum of thirteen weeks unless a Reciprocal Agreement exists.
  • if they is detained in prison as the benefit cannot be paid for any part of a prison sentence
  • if there are any changes in their circumstances that would affect the payment of benefit in respect of their spouse or partner.

Contribution Credits whilst claiming Long Term Incapacity Allowance

Contribution credits may be awarded following assessment for Long Term Incapacity Allowance. The length of time credits are awarded is based on a sliding-scale dependant on the percentage of Long Term Incapacity Allowance payable. they will not be entitled to credits if they has chosen not to pay contributions.

 

The degree of incapacity in percentage terms The maximum number of months contribution credits that may be awarded
100 540 (45 years)
95 540
90 540
85 540
80 540
75 540
70 360
65 240
60 120
55 96
50 60
45 36
40 24
35 18
30 12
25 6
20 3

 

The decision on a claim for Long Term Incapacity Allowance

If the claimant is dissatisfied with the decision on their claim they may appeal within 28 days of the Medical Board's decision. they should contact Social Security for further information.

Incapacity Pension (ICP)

Incapacity Pension is paid as a compensation for the loss of earnings to people who, because of their loss of faculty, are unlikely to work again. Whilst claiming Incapacity Pension they must not work even in a voluntary or honorary capacity. Incapacity Pension is payable up to pension age.

Contribution conditions for the payment of Incapacity Pension

To receive Incapacity Pension two contribution conditions must be met.

 

First: Sufficient contributions must have been paid for at least six months at any time before the end of the relevant quarter. The relevant quarter can be establish from the table in para 47.

 

Second: The contribution record must give at least a 10% entitlement to Incapacity Pension. This is calculated by adding all the contributions they has paid and been credited with since they registered for Jersey Social Security purposes. For example they can get credits for periods of Incapacity, unemployment and so on.

How to establish the relevant quarter for the payment of Incapacity Pension

    1.  

      If Incapacity Pension begins at some time in the quarter: The relevant quarter that affects payment of Pension is:
      January - March July - September in the previous year
      April - June October - December in the previous year
      July - September January - March in the same year
      October - December April -June in the same year

       

       

The rate of Incapacity Pension will be calculated by adding all the contributions and credits they has accrued up to the date they qualifies for Incapacity Pension. their contributions will be deemed as having been paid from the date they qualifies for Incapacity Pension to the month before they reaches pension age. To get 100% Incapacity Pension the contribution record, including the deemed contributions must total 45 years. If the contribution record is 80% full they will qualify for 80% of the standard rate of Incapacity Pension.

Rates of Incapacity Pension

The standard weekly rate of benefit can be found at 9.0.0.L2. The rate is reviewed on 1 October every year and increases in line with the Jersey Earnings Index for the 12 months ending on 30 June of the same year.

How to claim Incapacity Pension

If, as a result of loss of faculty, they is unlikely to work again they may be able to claim Incapacity Pension. In the first instance, they will be asked to complete a claim form for Long Term Incapacity Allowance.

 

they will be asked to attend a Medical Board, which consists of two doctors who will assess the loss of faculty. If the Medical Board agrees that their loss of faculty is such that they will probably not return to work they will be given a form to complete for Incapacity Pension. they will not need to send in Medical Certificates when the Incapacity Pension has been awarded however, they may be asked to attend further routine Medical Boards.

How Incapacity Pension is paid

Incapacity Pension is paid on a Thursday, four weekly in advance. The payment will be made directly to the claimant's bank account.

Other benefits payable whilst claiming Incapacity Pension

Two payments from Social Security funds cannot always be made for the same period. It is important that they tells Social Security if they is receiving Social Security Benefits from any other country when they completes their claim form.

Claiming an increase of Pension for a wife

A man can claim an increase of Incapacity Pension if;-

 

 

  • His wife is under 65
  • His date of marriage was before 1 April 2001
  • His wife is residing with him or is mainly maintained by him

 

This increase may not be payable if his wife is claiming another Social Security benefit in her own right.

Change in circumstances whilst being paid Incapacity Pension

A claimant must tell Customer and Local Services:-

 

 

  • If they changes address or bank account so that they can continue to receive their pension
  • In advance if they plans to leave Jersey, indicating the country they intends to visit. Incapacity Pension is payable worldwide
  • If they is detained in prison as benefit cannot be paid for any part of a prison sentence
  • If there are any changes in circumstances that would affect the payment of benefit in respect of his wife

If their condition improves and they returns to work

If they return to work they MUST notify Customer and Local Services immediately. Incapacity Pension would cease but they may still be entitled to Long Term Incapacity Allowance.

The decision on a claim for Incapacity Pension

If a claimant is dissatisfied with the decision on a claim they may appeal. they should contact Customer and Local Services for further information.