Sickness and Invalidity Benefits - Leaflet 16

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1 Sickness and Invalidity Benefits - Leaflet 16 This leaflet tells you about Sickness and Invalidity Benefits. General information and how to claim is set out on the following pages. If your incapacity is connected with an injury at work, you may be entitled to a different benefit, called Industrial Injury Benefit. To find out more you should ask for Leaflet 6. If you do not understand any of the information given in the leaflet, please seek advice from the Incapacity Benefits Section or Alderney States Office. The helpline number is This leaflet is for guidance and must not be treated as a complete and authoritative statement of the law. This leaflet should be read in conjunction with Leaflet 50 (Benefit Payment and Contribution Rates). How we collect and use information The Social Security Department collects personal information for social security purposes in accordance with the six laws which it administers. The information collected will depend on your business with us, but will be no more than is required for that purpose, and will not be further disclosed except as permitted by law. The Department complies with its legal duty under the Data Protection (Bailiwick of Guernsey) Law, and is the Data Controller for the purposes of that law. If you wish to know more about the information we have about you, or about the way we use it, you can ask at the Department's office. The Benefits What is Sickness Benefit? Sickness Benefit is a weekly benefit paid if you are incapable of work due to illness or injury. To get Sickness Benefit your claim must last at least 4 days and you must satisfy certain contribution conditions. What is Invalidity Benefit? Invalidity Benefit is a weekly benefit paid at a higher rate than Sickness Benefit. Generally speaking, it is paid after you have received Sickness Benefit for 6 months. As with Sickness Benefit, there are certain contribution conditions that you must satisfy before Invalidity Benefit can be paid. 1

2 Claiming How do I claim Sickness Benefit? A claim must be made in writing (in most cases this is the certificate given by your practitioner) and sent to the Department. A claim for Sickness Benefit should be made within 28 days from the start of your incapacity. Benefit may be lost if you do not claim on time. How do I claim Invalidity Benefit? Generally speaking, you will not have to make a separate claim for Invalidity Benefit. After you have received Sickness Benefit for 6 months the Department will let you know if you are entitled to Invalidity Benefit. What contributions count towards Sickness and Invalidity Benefit? There are two contribution conditions for Sickness and Invalidity Benefit. Before explaining what these conditions are, it is necessary to say something about contributions. Most workers are employed and pay Class 1 contributions and these count towards Sickness and Invalidity Benefit. Leaflet 40 gives information about employed persons and the contributions they have to pay. Someone who runs his or her own business is usually self-employed and pays Class 2 contributions. Class 2 contributions paid by self-employed people count towards Sickness and Invalidity Benefit. Leaflet 41 gives information about self-employed persons and the contributions they have to pay. People who are neither employed nor self-employed are treated as non-employed and, generally speaking, pay Class 3 contributions. Class 3 contributions never count towards the first contribution condition for Sickness and Invalidity Benefit but sometimes they can help with the second. Leaflet 42 gives information about nonemployed persons and the contributions they have to pay. What are the contribution conditions? Two contribution conditions must be met for you to get Sickness or Invalidity Benefit. The first is that you must have paid at least 26 contributions as an employed or self-employed person at any time in your working life. The second condition is that in the relevant contribution year you must have at least 26 contributions paid or credited as an employed or self-employed person. If you are claiming Sickness or Invalidity Benefit in the first six months of any year, the relevant contribution year on which the amount of benefit is based is the calendar year of two years before. If you are claiming benefit in the second six months of any year, the relevant contribution year is one year before. 2

3 If you do not satisfy the contribution conditions, you should still claim benefit. This is because the Department may be able to award contribution credits and this will help to protect your contribution record while you are unable to work. If you have any doubts about what to do, please seek advice from the Incapacity Benefits Section. The helpline number is What happens about my contributions while I am unable to work? If you are employed If you are employed and continue to receive wages, you will still be liable to pay contributions in the normal way. The earnings on which the contribution will be calculated will be reduced by the amount of any benefit you repay to your employer. If you are employed but do not receive wages, you will receive a credit for any contribution week during which you are incapable of work for 4 days or more. This is done to protect your contribution record while you are unable to work. If you are self-employed If you are self-employed, you will not be liable for a contribution. You will receive a credit for any contribution week during which you are incapable of work for 4 days or more. What if my employer is still paying me? You can still claim Sickness and Invalidity Benefit even if you continue to be paid by your employer. But, you may have to give your employer any benefit that you receive. This is a matter between you and your employer. Any payments you receive from a friendly society, trade union or private insurance policy will not affect your right to Sickness or Invalidity Benefit. Who can say I am incapable of work? Generally speaking, only a doctor, dentist, physiotherapist, osteopath or chiropractor can say that you are incapable of work. They can do this by completing a medical certificate. If your doctor thinks you are unable to work they will give you two copies (one pink, one green) of Form IB. The pink copy is for you to complete and take or send to the Social Security Department. If you live in Alderney, you can take or send it to the States Office. The pink Form IB is your claim for benefit and it is important that you fill it in and send it to the Department straightaway. If the form is not returned promptly, you might lose benefit. The green copy is to give to your employer. Dentists, physiotherapists, osteopaths and chiropractors use a slightly different form Form S but the idea is the same; you get two copies - the gold copy is used to make your claim and the second copy is to give to your employer. 3

4 What does incapable of work mean? You are incapable of work only if there is no work that you can be reasonably expected to do. If you cannot do physical work but you can do work of a supervisory or managerial nature, you may not be entitled to Sickness or Invalidity Benefit. In some circumstances the Department may give permission for a person receiving Sickness or Invalidity Benefit to carry out a limited amount of work (usually as part of an agreed gradual return to work). If you are able to carry out work of any sort, either paid or unpaid (including voluntary work), you must inform the Incapacity Benefits Section before you start. The helpline number is What if I am self-employed? You must not carry out any work while claiming benefit without the Department s prior approval. This does not just mean the "hands on" part of self-employment, it includes activities such as managing or supervising a business or its workforce, pricing a job, dealing with correspondence and attending meetings. You must notify the Department if you are capable of or intend to do any of these things. The helpline number is How will my claim be decided? The Administrator of the Social Security Department is responsible in law for deciding claims. You will be told of his decision in writing and if you are not satisfied, you may appeal to the Tribunal within 28 days. The Tribunal is independent of the Department and consists of a chairman and two other members. If you want to appeal against a decision you should contact the Incapacity Benefits helpline on to obtain the relevant form. Payments How much benefit will I receive? The rate of benefit payable depends on the number of contributions paid or credited in the relevant contribution year. The relevant contribution year is explained in the section headed - What are the contribution conditions. The full rates of each benefit are quoted in leaflet 50 (Benefit Payment and Contribution Rates). Although Sickness and Invalidity Benefit are paid once a week, benefit is calculated on a daily basis. This means that you will receive benefit for each day you are unable to work because of your incapacity. We may also pay you a part-week depending on when your medical certificate expires. If you send in another certificate, any balance owing will be paid on the next payday. 4

5 How will my benefit be paid? Once your claim has been dealt with and if benefit is due, it will be paid on a weekly basis in arrears. The Department tries to pay the majority of benefit claims directly into a bank account. However, as Sickness Benefit is normally passed back to an employer this is often paid by a weekly voucher instead. If your address is unsafe or this arrangement is not suitable, please let the Incapacity Benefits Section know straightaway. Entitlement to benefit is lost after 12 months if the voucher has not been cashed. Instead of a weekly voucher, Sickness Benefit can be paid directly into your bank account if you prefer. To find out more please call the Incapacity Benefit helpline on Please note that Invalidity Benefit will always be paid directly to your account and this will be arranged with you at the appropriate time. If you do not have a bank account, you will need to visit a bank and ask to open an account. Basic bank accounts are available from a number of banks. What if I lose or do not receive my voucher? If you lose your voucher or it does not arrive in the post on the day it is due please call the Incapacity Benefits helpline on Keeping your claim running For how long can I receive Sickness or Invalidity Benefit? You will receive Sickness or Invalidity Benefit for as long as you remain incapable of work and satisfy all the conditions explained in this leaflet. Generally speaking, after receiving Sickness Benefit for 6 months you will be paid Invalidity Benefit instead. But, neither benefit is paid once you reach pensionable age. Sometimes, Sickness or Invalidity Benefit may be stopped or reduced for other reasons. For example this may be because you no longer satisfy, or only partly satisfy the second contribution condition. If this happens, you will receive an explanation in writing. How often must I send in certificates? Claiming Sickness or Invalidity Benefit will depend on you being able to show you cannot work because of your illness or injury. This usually means sending in further medical certificates from your practitioner. Certificates should be submitted straightaway, as benefit may be lost if you do not claim within 3 months from the date of incapacity. If you have an ongoing claim, it is important that you know when your medical certificate is due to expire, so that you can submit a new form promptly. This will avoid any delay in receiving your benefit. 5

6 What are the Back to Work Benefits? These are benefits aimed at helping people get back to work after an illness and include things like training and options for a gradual return to work. The Department s work rehabilitation team are available to help you find suitable new employment if you are no longer able to return to your previous job. To find out how we can help you back to work please call the Incapacity Benefits helpline on or refer to Leaflet 11 (Back to Work Benefits). What is therapeutic work? Therapeutic work is work which you can do if it forms part of a treatment plan designed to improve your health or increase your capacity for paid employment following long-term illness. The purpose of this would be to allow you to use the opportunity as a stepping stone to permanent paid employment. You must get the Department s agreement and also your doctor s support for this before you start. There are strict rules about therapeutic work and the Department considers each case on its own merits. What supported employment services are available? Guernsey Employment Trust or (GET) aims to provide support and help to people who have difficulty finding and maintaining employment because of a physical or sensory disability or suffer from an enduring mental illness. But before they can consider helping you an application to the service will be required. Your doctor or relevant medical professional may be asked to support your application. If you think that GET might be right for you, please ask for more details by calling them on How are claims monitored? Most illnesses or injuries only last for a short time. For example, it would be very unusual for anyone with flu not to be able to return to work after 5 to 8 days. But sometimes there may be very good reasons why someone takes a bit longer to recover. The Administrator has to review all claims to benefit on a regular basis and we will contact you to obtain updates on your condition and how you are progressing. Depending on your situation we may contact you by telephone, ask you to come into the office or send a review form to you in the post. The Department also engages a doctor as its Medical Adviser who is able to discuss the medical aspects of a case with the treating doctor. Consent for this is included on each medical certificate you sign. What is the Work Capability Assessment? The Work Capability Assessment provides the Administrator with an independent opinion about how a person s illness affects their ability to work. The assessment is carried out by doctors drawn from a panel of local GPs. The doctors doing the 6

7 assessment will undertake a medical examination and will ask a series of questions before producing a report for the Administrator. Will I be asked to attend a Work Capability Assessment? Depending on the nature and length of your claim, you may be asked to attend a Work Capability Assessment. If you are asked to attend a Work Capability Assessment we will write to you to confirm the details. What happens after a Work Capability Assessment has taken place? After the examination has taken place the completed report is sent to the Administrator to review. The Administrator then decides what action to take regarding your claim. You will receive a letter telling you what the Administrator has decided and a copy of that letter and the Work Capability Assessment report will be sent to your own doctor. Changes in circumstances What happens if I work but do not inform the Department? If you carry out work, without the Department s permission, while claiming Sickness or Invalidity benefit, you may be committing an offence under the Social Insurance (Guernsey) Law, The Department takes such matters seriously and does not hesitate to refer cases to the Law Officers of the Crown for prosecution. If you are in any doubt whatsoever about what is meant by work, please seek advice from the Incapacity Benefits Section. What happens if I leave the Island? If you leave the Island for any period of time, you must inform the Incapacity Benefits Section before you leave. The Administrator will then decide if benefit can be paid for the day(s) that you are away. The helpline number is What happens if I am sent to prison? You must tell the Department if you are sent to prison whilst you are receiving Sickness Benefit or Invalidity Benefit. The helpline number is Benefits are not payable whilst you are in prison. What happens if I do not declare changes in my circumstances? If you fail to declare any changes in your circumstances while receiving benefit or if you deliberately misrepresent your circumstances in order to get benefit, you may be prosecuted. If your circumstances change you must inform the Incapacity Benefits Section without delay. The helpline number is

8 Special cases What if I have just left school? There are special rules that allow contribution credits to be given if you have just left school. This means that if you go straight into work from school and that work lasts for at least 26 weeks (not necessarily consecutive weeks), you may be entitled to Sickness Benefit if you become unfit for work later on. To find out more you should call the Incapacity Benefits helpline on What if I have just finished college or university? There are special rules that allow contribution credits to be given to help young people who have just left college or university. These rules mean that you may be entitled to Sickness Benefit soon after the end of your course or period of training. To find out more you should call the Incapacity Benefits helpline on What happens if I have just returned to the island and I am incapable of work? Not everyone who has just returned to the Island and is incapable of work will be entitled to Sickness or Invalidity Benefit. Contributions paid to some other countries may be used to help your claim. To find out about your particular case please call the Incapacity Benefits helpline on What if I work on a boat or ship and become unfit for work while abroad? There are special rules for people who work on boats or ships and become incapable of work while abroad. To find out more you should contact the Incapacity Benefits helpline on What if I don't have enough money to live on? If you are having difficulty managing on your income, the Supplementary Benefit Section may be able to assist you. Please call the Supplementary Benefit helpline on The supplementary benefit team will be pleased to give a general indication of your entitlements before you have to make a formal claim. What to do if you have a complaint If you are dissatisfied with any aspect of our service please let a member of staff know at the time so that we can try to resolve the issue immediately. If you wish to make a formal complaint to the Department, please contact us and ask for a complaints leaflet or download a leaflet from the States website (follow the links to Social Security, Complaints & Appeals, Customer Service Complaints ) and return the completed complaints form to the Chief Officer, Social Security Department, Edward T Wheadon House, Le Truchot, St Peter Port, Guernsey, GY1 3WH. Alternatively you can scan and the completed form to us at A senior officer will then investigate your complaint in accordance with the Department s Complaints Policy. 8

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