THE NATIONAL HEALTH SERVICE SUPERANNUATION SCHEME (SCOTLAND) EMPLOYERS GUIDE INJURY BENEFITS

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1 THE NATIONAL HEALTH SERVICE SUPERANNUATION SCHEME (SCOTLAND) EMPLOYERS GUIDE

2 SECTION 13. NHS SCHEME 13.1 Overview 13.2 Applying for Injury Benefits SPPA EMPLOYERS GUIDE 2

3 13.1 Overview of NHS (Scotland) (Injury Benefits) Regulations 1998 The NHS Injury Benefits Scheme covers almost all NHS employees, including General Practitioners and Dental Practitioners. The main exceptions being GP Practice staff and the majority of employees with Direction Body status. The governing regulations are not part of the NHS Pension Scheme and eligibility to claim Injury Benefits does not rely on superannuation scheme membership. However, any pension paid from the NHS superannuation scheme is taken into account when calculating an Injury Benefit. The NHS Injury Benefit Scheme is a no blame income protection scheme, which provides income protection for employees who suffer a loss of earnings, as a result of an injury, disease or condition that is wholly or mainly attributable to the duties of their NHS employment. No benefits would be payable if the injury or disease was seriously aggravated by the employee s own culpable negligence or misconduct. If a claim is accepted, the employee may receive payment if; They are temporarily absent from work (usually certified sick leave) on reduced or no pay. A Temporary Injury Benefit (TIB) makes up their total reckonable income (which includes certain Department of Work & Pensions (DWP) benefits) to 85% of their average pay. Payment of TIB does not automatically lead to payment of Permanent Injury Benefit (PIB) and if/when the employee returns to work on full pay, TIB will stop. Until SPPA are advised of the employee s return to work, TIB will continue to be considered, however, it is a temporary benefit. SPPA EMPLOYERS GUIDE 3

4 Their permanent degree of earning ability is reduced by more than 10% following termination of employment, or re-employment at a lower income due to the injury. All PIB applications are sent to SPPA s independent medical adviser for advice on acceptance and banding. If accepted the amount payable is variable and divided into five bands dependant on the degree of permanent loss of earning ability and length of NHS employment. PIB is payable for life. They die as a result of the injury or disease, leaving a spouse and/or dependants. When calculating any Injury Benefit, other sources of income are taken into account. These include NHS scheme pension, further NHS earnings, certain personal pensions and any relevant DWP benefits. Once TIB is awarded it is paid until the employee returns to work, is re-employed or employment is terminated. TIB can also be paid if employee is on reduced pay whilst on a phased return to work. The employer is recharged for all TIB and due to above it is their responsibility to monitor employee s absences. Re-employment is similar to superannuation scheme. If the combined reemployment earnings exceed the pre-retirement earnings then the PIB is reduced accordingly. Re-employed earnings for Injury Benefit abatement purposes includes any NHS superannuation pension in payment. The Injury Benefit will be abated before the NHS superannuation pension. SPPA EMPLOYERS GUIDE 4

5 A damages or compensation award made in respect of the same injury may affect the applicant s benefits and some or all of the money paid under the Injury Benefit Scheme may have to be recovered or offset against future benefits. If an employee claims damages the employer s legal advisers should be made aware of the Injury Benefit application. When a claim for damages is settled, it is essential the employer notifies the SPPA immediately. Regulation 17 gives SPPA authority to withhold or reduced Injury Benefits or in some cases request repayment of all or some of the benefits already paid if the applicant received damages/compensation at a later date. All benefits paid under the NHS Injury Benefit Scheme are index linked and are recharged to the relevant employer on a monthly basis. A booklet which provides more information and guidance to the Injury Benefits Scheme is available from our website SPPA EMPLOYERS GUIDE 5

6 13.2 Applying for Injury Benefit Anyone wishing to apply for NHS Injury Benefits should complete pages 1+ 2 of the INJ 1 application form available from our website, then forward to the Employer with the following information: Copies of GP or medical reports relevant to the injury/condition, including information on any pre-existing condition if applicable* Witness statements and or witness contact details Copies of any relevant DWP benefit awarding letters & medical reports *Please note the applicant is responsible for the payment of any fees requested for the provision of such information. SPPA require the Employer to supply the following information: An accident/incident report form All relevant reports held by Occupational Health, including details on any pre-existing and or related conditions Applicant s job description Any other relevant information SPPA EMPLOYERS GUIDE 6

7 In order to prevent any unnecessary delays and to avoid causing the applicant possible hardship, in addition to the completed INJ 1 form it is important the above information is provided. It is advisable that all injury applications and supporting information should be sent by Recorded Delivery for the attention of the NHS Injury Benefits Section. ALL sections in the Employer part of the INJ 1 form must be completed in full. Contact names and telephone numbers are essential. The requested information must be provided where possible. If, for any reason, you are unable to do so please provide a written statement to verify this. Please ensure that the Payroll Department has completed sections 3-5. Pay figures should be provided in the requested format and the SPPA s Injury Benefits Section must be informed of any changes in the pay or dates as soon as possible. SPPA will advise NHS payroll of an applicant s acceptance and for TIB, monthly pay figures should be provided on a regular basis to avoid late or non payment to the applicant. These pay figures should cover the period that the applicant goes on to reduced pay until the day the applicant returns to their post and contracted hours or their contract is terminated. SPPA EMPLOYERS GUIDE 7

8 Any loss of earnings incurred during a phased return to work must also be submitted to the SPPA Injury Section, with a letter from the Human Resources or Occupational Health department supporting the employee s phased return. Any medical or private documents sent in with the completed application form should be in a sealed envelope clearly marked with the applicant s name, superannuation scheme reference number (if applicable) and National Insurance Number. Any incomplete application forms will NOT be processed by the SPPA and will be returned to the Employer for completion and the applicant advised accordingly. Please contact the NHS Injury Benefit Team direct if there are any questions regarding the scheme or issues with a specific application. -nhspen1@scotland.gsi.gov.uk. SPPA EMPLOYERS GUIDE 8