Incapacity benefit consists of three separate benefits:
- Short Term Incapacity
- Long Term Incapacity
- Incapacity Pension
These benefits may be payable when a person is incapable of working full time due to 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 that 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.
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 reaches 364 days, it may become Long Term Incapacity Allowance.
Contribution conditions for the payment of Short Term Incapacity Allowance
To receive Short Term Incapacity Allowance, two contribution conditions must be met.
- Sufficient contributions must have been paid for at least three months in the relevant quarter. Please see the table below.
- To receive the full rate of benefit you must have paid (or have been credited with) sufficient contributions for each of the months in the relevant quarter. Sufficient contributions mean your earnings must have been more than the lower threshold level for a particular month. If you are a Class 2 Contributor, you must have paid contributions at the required level. The amount of the lower threshold level changes each January, see Social Security Contributions.
You will receive a reduced rate benefit if you meet the first condition and if you have paid enough contributions for at least one month in the relevant quarter. Benefit cannot be paid if you have not paid enough contributions in any of the months in the relevant quarter. However, you should send in the certificate even if you are not entitled to the allowance, as you may be entitled to contribution credits.
If any of the necessary contributions have been paid late, you may lose benefit.
Jersey has agreements with several countries. If you have recently arrived from any of these countries, the payments 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|
How to claim Short Term Incapacity Allowance
When you are unfit for work because of an illness or injury you should:-
- Ask your doctor or the hospital for a medical certificate.
- Fill in the certificate carefully to avoid any unnecessary delay in the processing of your claim.
- Send the completed certificate to Customer and Local Services within 30 days of the date you became incapable of work, otherwise, you may lose benefit.
The first certificate in your claim to benefit must not cover a period of more than 28 days. Your doctor may issue further certificates for a maximum of 13 weeks if they think the incapacity may be prolonged.
How Short Term Incapacity Allowance is paid
The benefit will usually be paid weekly in arrears. The benefit can be paid to your employer, your bank account or by cheque. The cheque can be cashed at a Post Office. You should contact Customer and Local Services if you are unable to sign the cheque so that arrangements can be made for someone of choice to cash the cheques on your behalf. The Post Office will require you 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 your spouse or partner is claiming Home Responsibility Protection and:
- is residing with you, or
- is mainly maintained by you
This increase may be reduced if the 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 you are receiving any other benefits from another country when you complete their medical certificate.
Changes in circumstances
You must tell Customer and Local Services if:
- There are any changes in circumstances that would affect the payment of benefit in respect of your spouse or partner
- There is a change of address, so you can continue to receive the payment on time
- In advance, if you plan to leave Jersey (even temporarily) indicating the country you intend to visit and the dates you intend to remain there. You may be able to receive Short Term Incapacity Allowance if you are resident in a country that is party to a reciprocal agreement with Jersey that covers this benefit
- If you are detained in prison as the benefit cannot be paid for any part of a prison sentence
- If you intend to do any work, even in a voluntary capacity
- If you have recently arrived in or returned to the Island. Reciprocal Agreements exist between many countries and Jersey so if you have not paid sufficient contributions in Jersey to qualify for Short Term Incapacity Allowance, it may be possible to use the contributions 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 you are receiving Short Term Incapacity Allowance. The purpose of credits is to protect your contribution record for any future claims to Incapacity Benefit. They also protect entitlement to pension. You will not be awarded credits if you have 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, you may be required to attend a Medical Board for examination by an independent doctor. If you fail to attend without a valid reason, or if you refuse to be examined, you may be disqualified from receiving benefit for up to six weeks.
Claims are decided by a Determining Officer at Customer and Local Services. If you are dissatisfied with the decision on your claim, you may appeal to the Social Security Tribunal.
You must lodge your 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 compensation for reduced capacity to work. You 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, the same two contribution conditions as above must be met.
Rates of benefit paid for Long Term Incapacity Allowance
The standard weekly rate of benefit can be found here. 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 assessed as a percentage of the standard rate. This percentage is decided by the Social Security Medical Board. To qualify, you must have an assessment of at least 5%. An assessment of between 5% and 15% is paid as a lump sum. The Medical Board will not tell you the percentage of your assessment when they attend. You will be advised in writing.
How to claim Long Term Incapacity Allowance
If you have claimed Short Term Incapacity Allowance for a maximum of 364 days, you will be sent a form to claim Long Term Incapacity Allowance. If you have some reduced capacity but return to work or your doctor does not consider that you are totally unable to work, you may obtain a claim form from Social Security. You do 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.
You will be asked to attend a Medical Board which usually consists of two doctors. You may submit any evidence in support of your claim. Your doctor will be told that you are attending a Medical Board and asked to submit relevant information.
Medical Board assessment
The Medical Board will assess the percentage of your reduced capacity within the agreed guidelines. If you are entitled to more than one claim to Long Term Incapacity Allowance, the percentages are added together up to a maximum of 100%. An initial assessment will usually be provisional i.e. for a limited period. Subsequent assessments may be final indicating a permanent reduction of capacity. Long Term Incapacity Allowance may be paid until pension age.
How Long Term Incapacity Allowance is paid
Long Term Incapacity Allowance is paid four weekly, in advance. The payment will be made directly to your bank account.
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 the percentage of Long Term Incapacity Allowance payable. You will not be entitled to credits if you have 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)|
The decision on a claim for Long Term Incapacity Allowance
If you are dissatisfied with the decision on your claim, you may appeal within 28 days of the Medical Board’s decision.
Incapacity Pension (ICP)
Incapacity Pension is paid as compensation for the loss of earnings to people who are unlikely to be able to work again. Whilst claiming Incapacity Pension you 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, the same two contribution conditions as above must be met.
The rate of Incapacity Pension will be calculated by adding all the contributions and credits accrued up to the date you qualify for Incapacity Pension. Your contributions will be deemed as having been paid from the date you qualify for Incapacity Pension to the month before you reach pension age. To get 100% Incapacity Pension the contribution record, including the deemed contributions, must total 45 years. If the contribution record is 80%, you will qualify for 80% of the standard rate of Incapacity Pension.
Rates of Incapacity Pension
The standard weekly rate of benefit can be found here. The rate is reviewed on 1 October every year.
How to claim Incapacity Pension
If you are unlikely to work again, you may be able to claim Incapacity Pension. In the first instance, you will be asked to complete a claim form for Long Term Incapacity Allowance.
You will be asked to attend a Medical Board, which consists of two doctors. If the Medical Board agrees that your reduced capacity is such that you will probably not return to work, you will be given a form to complete for Incapacity Pension. You will not need to send in Medical Certificates when the Incapacity Pension has been awarded, however, you may be asked to attend further routine Medical Boards.
How Incapacity Pension is paid
Incapacity Pension is paid 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 you Social Security if you are receiving Social Security Benefits from any other country when you complete your 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
You must tell Customer and Local Services:-
- If you change address or bank account so that you can continue to receive their pension
- In advance, if you plan to leave Jersey, indicating the country you intend to visit. Incapacity Pension is payable worldwide
- If you are 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 your wife
If your condition improves and you return to work
If you return to work you must notify Customer and Local Services immediately. Incapacity Pension would cease but you may still be entitled to Long Term Incapacity Allowance.
The decision on a claim for Incapacity Pension
If you are dissatisfied with the decision on a claim, you may appeal within 28 days.