Citizens Advice Bureau

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LOCAL INFORMATION

9.8.8.L1
Incapacity Benefits

Extent: Jersey
03 September 2004
Updated 31 July 2014
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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, s/he must not behave in a way which might delay her/his 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 s/he 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 her/his earnings must have been more than the lower threshold level for a particular month. If the claimant is a Class 2 Contributor s/he must have paid contributions at the required level. The amount of the lower threshold level changes each January, see 9.8.0.L4.

 

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

 

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

 

Jersey has Social Security agreements with several countries. If the claimant has recently arrived from any of these countries the payments s/he 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 s/he should:-

 

  • Ask her/his doctor or the hospital for a medical certificate.
  • Fill in the certificate carefully to avoid any unnecessary delay in the processing of her/his claim.
  • Send the completed certificate to the Department within 30 days of the date s/he became incapable of work, otherwise s/he may lose benefit.

 

The first certificate in her/his claim to benefit must not cover a period of more than 28 days. Her/his doctor may issue further certificates for a maximum of 13 weeks if s/he 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 her/his bank account. S/he should contact the Department if s/he is unable to sign the cheque so that arrangements can be made for someone of her/his choice to cash the cheques on her/his 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 her/him or
  • is mainly maintained by her/him.

See 9.8.0.L5

 

This increase may be reduced if her/his spouse or partner is receiving another Social Security 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 the Department if s/he is receiving any other Social Security benefits from another country when s/he completes her/his medical certificate.

Changes in circumstances

The claimant must tell the Social Security Department:-

 

 

  • If there are any changes in her/his circumstances that would affect the payment of benefit in respect of their wife or partner.
  • If s/he changes address so that s/he can continue to receive the payment on time.
  • In advance if s/he plans to leave Jersey (even if temporarily) indicating the country s/he intends to visit and the dates s/he intends to remain there. S/he may be able to receive Short Term Incapacity Allowance if s/he is resident in a country which is party to a reciprocal agreement with Jersey that covers this benefit.
  • If s/he are detained in prison as the benefit cannot be paid for any part of a prison sentence.
  • If s/he intends to do any work, even in a voluntary capacity.
  • If s/he has recently arrived in or returned to the Island. Reciprocal Agreements exist between many countries and Jersey so if s/he has not paid sufficient contributions in Jersey to qualify for Short Term Incapacity Allowance it may be possible to use the contributions s/he 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 her/his contribution record for any future claims to Incapacity Benefit. They also protect her/his entitlement to pension. S/he will not be awarded credits if s/he 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 s/he may be required to attend a Medical Board for examination by an independent doctor. If s/he fails to attend, without a valid reason, or if s/he refuses to be examined, s/he may be disqualified from receiving benefit for up to six weeks.

 

Claims are decided by a Determining Officer at the Social Security Department. If the claimant is dissatisfied with the decision on her/his claim s/he may appeal to the Social Security Tribunal.

 

Please note: S/he must lodge her/his 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 - S/he must have paid sufficient contributions for at least six months at any time before the end of the relevant quarter.

 

Second - S/he must have paid (or have been credited) sufficient contributions in the relevant quarter. Sufficient contributions means her/his earnings must have been more than the lower threshold level for a particular month. If s/he is a Class 2 Contributor s/he 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 s/he 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 the Social Security Department 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 s/he 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 s/he 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 her/his assessment when s/he attends. S/he will be advised in writing within a few days.

How to claim Long Term Incapacity Allowance

If s/he has claimed Short Term Incapacity Allowance for the maximum 364 days s/he will then be sent a form on which to claim Long Term Incapacity Allowance. However, if s/he has some loss of faculty but return to work or her/his doctor does not consider that s/he is totally incapable for work s/he may obtain a claim form from Social Security. S/he 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 the Social Security Department immediately to avoid loss of benefit.

 

The claimant will be asked to attend a Medical Board which usually consists of two doctors. S/he may submit to the Medical Board any evidence in support of her/his claim. Her/his doctor will be told that s/he is attending a Medical Board and asked to submit relevant information.

Medical Board assessment

The Medical Board will assess the percentage of her/his loss of faculty within the agreed guidelines. If s/he 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 her/his 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 s/he is receiving Social Security benefits from any other country when s/he completes the claim form. If s/he is receiving Long Term Incapacity Allowance which is less than the standard rate the amount would be adjusted. Further information is available from the Social Security Department.

Claiming an increase of benefit for your Spouse or Partner

S/he can claim an increase in her/his benefit if her/his spouse or partner is claiming Home Responsibility Protection and:-

 

 

  • is residing with her/him or
  • is mainly maintained by her/him.

See 9.8.0.L5

Changes in circumstances

The claimant must tell Social Security;-

 

 

  • if s/he changes address or bank account so that s/he can continue to receive her/his benefit
  • in advance if s/he plans to leave Jersey, indicating the country s/he intends to visit. S/he can receive Long Term Incapacity Allowance whilst residing outside Jersey for a maximum of thirteen weeks unless a Reciprocal Agreement exists.
  • if s/he is detained in prison as the benefit cannot be paid for any part of a prison sentence
  • if there are any changes in her/his circumstances that would affect the payment of benefit in respect of her/his 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. S/he will not be entitled to credits if s/he 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 her/his claim s/he may appeal within 28 days of the Medical Board's decision. S/he 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 s/he 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 s/he has paid and been credited with since s/he registered for Jersey Social Security purposes. For example s/he 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 s/he has accrued up to the date s/he qualifies for Incapacity Pension. Her/his contributions will be deemed as having been paid from the date s/he qualifies for Incapacity Pension to the month before s/he 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 s/he 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, s/he is unlikely to work again s/he may be able to claim Incapacity Pension. In the first instance, s/he will be asked to complete a claim form for Long Term Incapacity Allowance.

 

S/he 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 her/his loss of faculty is such that s/he will probably not return to work s/he will be given a form to complete for Incapacity Pension. S/he will not need to send in Medical Certificates when the Incapacity Pension has been awarded however, s/he 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 s/he tells Social Security if s/he is receiving Social Security Benefits from any other country when s/he completes her/his 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 the Social Security Department:-

 

 

  • If s/he changes address or bank account so that s/he can continue to receive her/his pension
  • In advance if s/he plans to leave Jersey, indicating the country s/he intends to visit. Incapacity Pension is payable worldwide
  • If s/he 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 her/his condition improves and s/he returns to work

If s/he return to work s/he MUST notify the Social Security Department immediately. Incapacity Pension would cease but s/he 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 s/he may appeal. S/he should contact the Social Security Department for further information.