Industrial Injuries Benefits - Leaflet 6

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1 Industrial Injuries Benefits - Leaflet This leaflet tells you about Industrial Injury Benefit, Industrial Disablement Benefit and Industrial Medical Benefit. Together these are known as Industrial Injuries Benefits. They exist to help employed or self-employed people who have suffered an accident at work or have contracted certain diseases or conditions while at work. These diseases or conditions are known as Prescribed Industrial Diseases. 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 it 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. General Who can claim Industrial Injuries Benefits? To become entitled to these benefits you do not need a contribution record. But you must have been employed under a contract of service or been liable for selfemployed contributions at the time you had the accident or contracted the condition or disease. Who cannot claim Industrial Injuries Benefits? Self-employed people over the age of 65 cannot claim these benefits. Self-employed people whose earnings are less than the Lower Earnings Limit and who are not required to pay contributions as self-employed people cannot claim these benefits. The current Lower Earnings Limit can be found in Leaflet 50. 1

2 How do I claim Industrial Injuries Benefits? Claims for Industrial Injuries Benefits are made by filling out the back of medical certificates. The certificate asks questions that allow you to either say that you have had an accident at work or have contracted a prescribed disease at work. Other questions allow you to say that you have had treatment that relates to a previous claim. Industrial Injury Benefit What is Industrial Injury Benefit? Industrial Injury Benefit is a weekly benefit that can be paid if you are unable to work for at least 4 days due to an accident at work. It can also be paid if you are unable to work because for at least 4 days you have contracted certain diseases or conditions while at work. It can be paid to employed and self-employed people. How is Industrial Injury Benefit paid? Once your claim has been dealt with and if benefit is due it will be sent out each week in the form of a voucher. This can be cashed at any branch of the NatWest Bank or paid into your account. 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. The helpline number is How much Industrial Injury Benefit will I receive? Benefit is only sent out twice a week (normally Monday & Wednesday). If you have an ongoing claim it is important that you submit medical certificates during the week before the next payment is due to be sent out to avoid any delay in receiving your benefit. We may also pay you a part-week depending on when you submit your medical certificate. If this happens, you will receive the balance if we pay you the following week. If you are due a part-week at any stage you will be paid 1/7 th of the weekly rate of each day. Claiming How soon must I claim? If you are claiming because you are incapable of work due to your illness or condition you must claim within 3 months. If you do not claim within 3 months you may lose benefit. Entitlement is lost altogether after 12 months. 2

3 What if my employer is still paying me? You can still claim Industrial Injury 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 Industrial Injury Benefit. While you 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. 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 While you are receiving Industrial Injury Benefit you will not be liable for a contribution. You may receive a credit for any contribution week during which you are incapable of work for 4 days or more. If you are entitled to a credit you will be informed. What does incapable of work mean? You are incapable of work only if there is no work that you can reasonably be 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 Industrial Injury Benefit. In some circumstances the Department may give permission for a person receiving Industrial Injury Benefit to carry out a limited amount of work (usually as part of programme of 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 Who can say I am incapable of work? Generally speaking, only a doctor, dentist, physiotherapist or osteopath can say that you are incapable of work. This is done on one of two special forms. Your doctor will give you two copies (one pink, one green) of Form K. The pink copy is for you to complete and take or send to the Department. If you live in Alderney you can take or send it to the States Office. 3

4 The pink Form K is your claim and it is important that you fill it in and send it to the Department straightaway. If you do not send it in straightaway you might lose benefit. The green copy is to give to your employer. Dentists, physiotherapists and osteopaths 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 blue copy is to give to your employer. 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 consists of an independent chairman and two members. An appeal to the Royal Court against the Tribunal s decision is restricted to a question of law. 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 Section helpline on How often must I send in certificates? If you are claiming Industrial Injury Benefit because you are incapable of work your right to carry on receiving that benefit depends on you sending in further certificates from your practitioner. Failure or delay in sending these certificates might lead to the loss of benefit. Generally speaking, once you have sent in your first certificate, you will be told when you need to obtain another one. But, if you do not send it in on time you might lose benefit. 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, gradual return to work and back to work bonus. To find out how we can help you back to work, call the Incapacity Benefits helpline on and ask for Leaflet 11 (Back to Work Benefits). How are Industrial Injury Benefit claims monitored? Most people will understand that the majority of illnesses or injuries cannot carry on forever. For example, it would be most unusual for anyone with a sprained ankle not to be able to return to work after 2 weeks or so. Sometimes, however, there may be very good reasons why someone may not be able to return to work. To help deal with these cases, a claimant may be visited at his or her home by one of the Department s Visiting Officers. 4

5 The Department also employs a doctor as its Medical Adviser. With the consent of the claimant, the Medical Adviser is able to discuss the medical aspects of a case with the practitioner who is treating the claimant. What is the Incapacity Advisory Board? The Incapacity Advisory Board (IAB) is a panel of two doctors that the Administrator can call upon to provide an independent opinion regarding a claimant s ability to undertake work. The Board undertakes an examination and asks a series of questions before producing a report for the Administrator. Will I be asked to attend an Incapacity Advisory Board? Not everyone who makes a claim for Industrial Injury Benefit will have to be examined by the Board. But if the Department s Medical Adviser thinks it is appropriate you will be asked to attend. You will receive the request to attend a Board in writing. What happens after an Incapacity Advisory Board has taken place? After the examination has taken place the report completed by the Board is sent to the Administrator. 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 Board s report will be sent to your own doctor. 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 What happens if I work but do not inform the Department? If you carry out work without the Department s permission while claiming 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 possible prosecution. If you are in any doubt whatsoever about what is meant by work please call the Incapacity Benefits helpline on 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

6 What happens if I am sent to prison? You must tell the Department if you are sent to prison whilst you are receiving Industrial Injury Benefit or Invalidity Benefit. The helpline number is Extra help What is Invalidity Benefit? Invalidity Benefit is a weekly cash benefit paid at a higher rate than Industrial Injury Benefit. Generally speaking it is paid after you have received Industrial Injury Benefit for 6 months. But, there are contribution conditions that you must satisfy before Invalidity Benefit can be paid. If you are not entitled to Invalidity Benefit you will continue to receive Industrial Injury Benefit. Invalidity Benefit is normally paid directly into your bank account and this will be arranged with you at the appropriate time. More information about Invalidity Benefit can be found in leaflet 16. 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 staff of that section will be pleased to give a general indication of your entitlements before you have to make a formal claim. What is therapeutic work? While you are still claiming benefit your doctor may suggest that you undertake a small amount of work to assist your recovery. Work undertaken on this basis is known as therapeutic work. There are strict rules about therapeutic work but if your doctor feels you should be trying this he should contact the Department on your behalf. What is the Supported Employment Scheme? The Supported Employment Scheme is run by the Health and Social Services Department and can help people who have difficulty finding work because of a learning disability, a physical or sensory disability or suffer from a mental illness. But before the Scheme can consider helping you your doctor may be asked to provide a report on your condition. If you think that the Supported Employment Scheme might be right for you please ask for more details by contacting the Incapacity Benefits helpline on

7 Industrial Disablement Benefit What is Industrial Disablement Benefit? Industrial Disablement Benefit is a weekly benefit that can be paid if you have a longterm disability as a direct result of an accident at work. It can also be paid if the disability is the result of certain diseases or conditions contracted at work. The degree of disability is decided by a Medical Board. You can receive this benefit and still go out to work. The benefit can still be paid to certain people over age 65. What is the Medical Board? The Medical Board exists to assess the degree of a person s disability or loss of faculty following an accident at work or following the contraction of a prescribed disease at work. If you are asked to attend a Board (examination) the request will normally be made in writing. Before the Board takes place your own doctor will be given the chance to provide information about your condition. During the Board you will be given the chance to explain how the condition affects your life. Once the Board has taken place you will receive a letter telling you what assessment was made. How much Industrial Disablement Benefit will I receive? This will depend on the assessment made by the Medical Board. The Board will award a percentage that indicates the effect of your disability. The rates payable based on these percentages are set out in Leaflet 50. If the Board assesses a person s degree of disability to be less than 20 per cent at any time benefit is not payable. 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. If you are not satisfied with the Administrator s decision you may appeal to the Tribunal within 28 days. The Tribunal consists of an independent chairman and two members. An appeal to the Royal Court against the Tribunal s decision is restricted to a question of law. How is Industrial Disablement Benefit paid? If benefit is payable it will be paid directly into your bank account. If this arrangement is not suitable please seek advice from the Incapacity Benefits Section. The helpline number is For how long will Industrial Disablement Benefit be payable? When a person is assessed by the Medical Board the Board also decides how long the assessment should last. Some assessments will be for life and others may be for fixed periods. You will be told how long the assessment lasts in your case. But sometimes the Department may ask the Board to see a person again before the 7

8 period of assessment ends because it believes there has been an unexpected recovery from the disability or condition. Claiming How do I claim Industrial Disablement Benefit? If your claim for Industrial Injury Benefit or Industrial Medical Benefit is accepted you may be entitled to claim Industrial Disablement Benefit. To receive Industrial Disablement Benefit you must have a long-term disability as a result of your accident at work or from the effects of a prescribed disease contracted at work. The form you need is available from the Department upon request. If you have not been off work as a result of the accident or disease you should claim straightaway. If you have been off work for less than 6 months you should claim as soon as you are fit for work again. If you have been off work for more than 6 months you should claim straightaway. What if I am unhappy with the Medical Board s assessment of my disability? If you are unhappy with an assessment made by the Board you can ask for your case to be looked at again. This can only happen if you have new medical evidence or the Board did not have all the relevant information at the time you were examined. You may also ask for your case to be looked at again if you have medical evidence to show that your condition has worsened. What if I am admitted to hospital? If you go into hospital as a direct result of the condition you may be entitled to extra benefit but to find out more please contact the Incapacity Benefits helpline on What happens if I am sent to prison? You must tell the Department if you are sent to prison whilst you are receiving Industrial Disablement Benefit. The helpline number is Accidents and Prescribed Diseases What is an accident? For the purposes of Industrial Injuries Benefits an accident is defined in law as: (a) a specific and undesigned or unforeseen event causing, but being separate and distinct from, personal injury; or (b) a specific instance of unusual physical exertion causing personal injury; excluding (for the removal of doubt) any case where:- 8

9 (i) (ii) an illness or pathological change is caused otherwise than by any such event or exertion; or the only specific and undesigned or unforeseen event is the personal injury itself. But, when you make your claim all you will have to do is say exactly what happened. The Department will decide if your claim can be treated as an accident as defined in law. What is a Prescribed Industrial Disease? There is a list of certain diseases and conditions that the Department can refer to. This is known as the list of Prescribed Industrial Diseases. If you contract a disease or condition as a result of your work and it is listed you may be entitled to benefit. But, when you make your claim all you have to do is tick the relevant box about prescribed diseases on the back of your medical certificate and explain what happened. The Department will decide if your claim can be treated as relating to a disease or condition on the list. The list of the Prescribed Industrial Diseases that the Department refer to can be found on the Department s web site at Follow the link to Legislation and click on the Social Insurance (Industrial Injuries Benefits) Regulations. The list is in the third schedule of the Regulations. How soon will my accident claim be accepted? If you claim that your illness or condition is the result of an accident at work or relates to a prescribed disease contracted at work the Administrator will decide if he can accept your claim. You will be told in writing if your claim is accepted. But if more information is needed you might be sent a questionnaire. Questionnaires are not sent out because the Department does not believe what a person has stated but simply because more information is needed before a decision can be made. What if my accident claim is not accepted? If your claim is not accepted you will be told in writing. If you are unhappy with the decision you should contact the Incapacity Benefits Section. If you are able to provide new information your claim can be looked at again. You can also submit a formal appeal and how to do this is explained in the section headed How will my claim be decided? Industrial Medical Benefit What is Industrial Medical Benefit? Industrial Medical Benefit is a benefit that is used to pay for treatment connected with your accident at work. It can also be used to pay for your treatment if you contract certain diseases or conditions at work. Once your claim for Industrial Injuries Benefits has been accepted local practitioners send the relevant medical accounts direct to the Department. 9

10 If you are treated by an osteopath, the Department will only pay grant and not the full cost of the treatment. You must at all times claim your Health Benefit grants. If you have paid any medical or para-medical accounts before you were advised that your claim had been accepted please call the Incapacity Benefits helpline on Please note that the Department will pay for physiotherapy which you require as the result of an accident at work. However, if the physiotherapy is recommended by a consultant, it would be covered under the Specialist Health Insurance Scheme and would be provided by the Guernsey Physiotherapy Group. If you choose to see a physiotherapist from a different practice, the cost would not be covered by the Industrial Medical Benefit Scheme. What is not paid for by Industrial Medical Benefit? Industrial Medical Benefit does not pay any prescription charges for drugs or medicines prescribed by your practitioner. The department will not pay any private medical accounts if you have chosen to have private treatment as a result of your accident or condition. If you need treatment off Island we would expect your doctor to refer you to the relevant NHS provider in the UK. How do I claim for treatment? You should send in a medical certificate each time that one is given to you following treatment. But the treatment will only be paid for by the Department for so long as it is satisfied that the treatment relates to an accepted claim. How do I make a complaint? If you are unhappy with the service that the Department has provided, please put your complaint in writing to: The Administrator Social Security Department Edward T. Wheadon House Le Truchot St Peter Port Guernsey GY1 3WH 10

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