NHS Injury Benefits Scheme A guide to available benefits Pensions Division The Personnel Office March 2009
Contents 2 General information 3 Temporary Injury Allowance (TIA) 4 Permanent Injury Benefit (PIB) 5 Who is eligible? 7 Applying for PIB 9 How to claim 10 Benefits payable 12 Benefits example 13 PIB and Social Security benefits 14 Damages and compensation 15 Who s covered 16 Death benefits 17 Further information Where do I go for help? How do I complain? The Pensions Advisory Service (TPAS) The Isle of Man Ombudsman 19 Glossary of terms 20 Small print 1
General information on the NHS Injury Benefits Scheme The NHS Injury Benefits Scheme is not part of the NHS Superannuation Scheme 2007 or the NHS Pension Scheme 2008. It is governed by different rules, and it covers all NHS employees and general practitioners (not GP or DP Practice Staff or Locum GPs), whether or not they are members of the NHS Pension Schemes. The Injury Benefits Scheme provides benefits for any NHS employee who as a result of an injury, disease or condition caused wholly or mainly by their NHS employment: Is on certified sick leave with reduced pay or no pay, or Has their earning ability permanently reduced by 11% or more, or Dies, leaving a spouse/or partner and/or dependants If after reading this booklet you want more information, details of how to get it are on page 17. This booklet is a general guide. It is not a full statement of the law which governs the Injury Benefits Scheme. The Injury Benefit Scheme is administered by the Pensions Division of the Personnel Office. A glossary of terms used in connection with the Injury Benefit Scheme is available to download. 2
Temporary Injury Allowance Temporary Injury Allowance is paid by employers to staff on authorised absence with reduced pay or no pay because of an injury or disease wholly or mainly attributable to their employment. TIA tops up the employee s income to 85% of the average they were getting before their pay was reduced as a result of the injury or disease. It is not payable if the employee s income is more than 85% of their average pay, and it stops when they return to work or leave employment. TIA is subject to income tax deductions but not National Insurance or pension contribution deductions. To qualify for TIA, an employee covered by the Scheme must be on leave of absence and be suffering a reduction in their NHS pensionable pay as a result of an injury or disease that is wholly or mainly attributable to their actual NHS duties. Applications for TIA should be made by the employee to their line manager or to their HR Office. Entitlement to TIA is decided by the claimant s NHS employer. However, where employers require assistance or advice in order to reach a decision, they can approach the Pensions Division for help. 3
Permanent Injury Benefit (PIB) Permanent Injury Benefit is available to NHS staff who suffer a permanent reduction in their earning ability from employment of more than 10%. It can be paid if the number of hours the employee can work is permanently reduced; if they have to change to a lower paid job; or if they have to leave their NHS employment. It is not payable if the permanent reduction in the employee s earning ability is 10% or less. The allowance is intended to top up the employee s income to a percentage of their average pay, dependent on length of service and the permanent reduction in earning ability. To qualify for PIB, the Pensions Division must be satisfied that an individual has suffered a permanent reduction in their earning ability of more than 10% as a result of an injury or disease that is wholly or mainly attributable to their actual NHS duties. Benefit awarded will be reduced, however, by income received by the applicant from a specific range of sources: these are pensions scheme (including their NHS Scheme), some social security benefits, and compensation received in connection with the illness or injury in question. A lump sum may also be payable if the applicant s NHS employment ends because of the injury or illness. This is also a percentage of the applicant s average pay but unlike the PIB allowance is not connected to the length of service. 4
Who is eligible? Pensions Division, in its capacity as scheme administrator, with advice from its Occupational Health advisers, decides upon an applicant s entitlement to PIB. The information on this page will help applicants assess their likelihood of receiving payments through the NHS Injury Benefit Scheme, should they submit a claim. Before an applicant can be regarded as having a successful claim for PIB, the scheme administrators must satisfy themselves that two criteria have been met by the applicant namely: they must be suffering from an injury or disease whose cause is wholly or mainly attributable to their NHS employment and they must have suffered a permanent loss of earning ability of more than 10%. Determining the permanent loss of earning ability involves looking at the applicant s average pay at the time the reduction in earnings or earnings ability took place and then assessing their earnings ability since that time. Assessment of earning ability since the illness/injury is based on evaluation by the Scheme s Occupational Health advisers of the applicant s capability for work in the general field of employment. Benefits may be awarded if the applicant has a successful claim, and these will be based on a percentage of the applicants average pay at the time the injury or illness was sustained, the number of years worked for the NHS at that time, and the level of permanent reduction in their earnings ability that resulted. The PIB benefits table shows how PIB is calculated for a specific case. A lump sum may also be payable if the applicant s NHS employment ends because of the injury or illness. This is also a percentage of the applicant s average pay and can be calculated from the table shown on Page 10. 5
In calculating the annual PIB allowance due to a successful claimant, the scheme administrators are required to deduct annual income applicants may be getting from pensions (NHS, SERPS or any other public or private sector pension scheme), from a range of specific social security benefits and from any compensation claims. As a result, there are some people who may have a successful claim for PIB but, because of income received from other sources, they will receive no actual payment from the Scheme. This does NOT mean PIB will NEVER be payable in these cases: if the applicant s condition deteriorates and with it their earning ability, or their income from a pension or social security payment stops, they can contact the scheme administrators for a review of the claim. 6
Applying for PIB Applicants need to make their application on Injury Benefits Application form, which is available from your HR Office or Pensions Division. Part of the form is completed by the employer and part of it by the applicant. Whilst employers can express an opinion as to an individual s entitlement to PIB they cannot deny an individual s right to apply for PIB. Applications can be completed whilst an employee is still employed, but the outcome cannot normally be decided until they have left their NHS employment or moved to a lower paid job. In the course of a PIB claim the employer must provide the scheme administrators with the following information: The injuries sustained or the disease contracted (i.e. the condition) by the applicant, its treatment and prognosis. How it is connected to their NHS duties (i.e. what caused it). How or whether the condition has caused a permanent reduction in earning ability. Employers must include, with the PIB application form copies of: All accident reports. Reports of any internal investigation connected with the claim. A full job description. Sick leave records. A full statement of events explaining what injury/disease the applicant is claiming for and the circumstances leading to the claim. Employers who do not support the claim must still provide a statement, and whatever other information the scheme administrators require to process the claim. Applicants are required to provide, on the application form, a statement explaining what happened, details of the illness/injury sustained and its effect on their ability to work and carry out daily activities. They are asked to check the information provided on the form by their employer and any other accompanying documentation, and to provide copies of all documents or reports in their possession that relate to their claim. 7
These might include things like accident book records, DHSS accident declarations or medical assessment papers, witness statements, GP or hospital records, compensation claims and any other evidence they think might be useful in supporting their claim. 8
How to claim The application form and supporting material will be passed to the scheme s medical advisers (Occupational Health, DHSS) who will assess the existence and effect of the injury or disease in the applicant s work. During this process the applicant may be asked for additional information/evidence which may include examination by an independent medical expert or functional analyst. The scheme administrators advised by their medical advisers will then decide whether the injury or disease claimed for is wholly or mainly attributable to the duties of the applicant s NHS employment and they will then be told if they have a successful claim for PIB. If it is agreed that the applicant s condition is wholly or mainly attributable to their NHS duties, the claim will go forward for assessment of the degree of permanent loss of earning ability (PLOEA), which in turn will determine the level of benefit payable. If the PLOEA is less than 10%, PIB will not be payable. This does NOT mean PIB will NEVER be payable: if the applicant s condition deteriorates further and with it their earning ability, they can contact the scheme administrators for a review of your claim. Determining the PLOEA involves looking at the applicant s earnings at the time the loss of earnings or earnings ability took place, and then assessing their earnings ability since that time. Assessment of earning ability since the illness/injury is based on evaluation by the Scheme s Occupational Health advisers of the applicant s capability for work in the general field of employment. If the applicant s claim for PIB has progressed to the stage where a permanent loss of earning ability has been established, the scheme administrators will then work out the PIB annual allowance applicable to their case. How they do this is explained on Page 10. Any payments awarded will usually be backdated to the start of the reduction in earnings or earnings ability. For those who remain in NHS employment on lower pay it will usually be from the start of the lower pay. For those who terminate their employment, it will be from the day after the termination of employment. 9
Benefits payable The PIB allowance for successful claimants is based on a percentage of their average pay at the time the injury or illness was sustained, the number of years worked for the NHS at that time, and the level of permanent reduction in earnings ability that resulted. The table below shows how PIB can be calculated for a specific case. A lump sum may also be payable if the applicant s NHS employment ends because of the injury or illness. This is also a percentage of the applicant s average pay but unlike the PIB allowance is not connected to the length of service. Permanent reduction of earning ability Length of NHS employment Less than 5 years 5-15 years 15-25 years 25 years and over Lump sum More than 10% up to 25% 15% 30% 45% 60% 12.5% More than 25% up to 50% 40% 50% 60% 70% 25% More than 50% up to 75% 65% 70% 75% 80% 37.5% More than 75% 85% 85% 85% 85% 50% In calculating the annual PIB allowance due to a successful claimant, the scheme administrators are required to deduct annual income applicants may be getting from pensions (NHS, SERPS or any other public or private sector pension scheme), from a range of specific social security benefits and from compensation claims. 10
Because of these deductions, there are some people who may have a valid claim for PIB but, because of income received from other sources, they will receive no actual payment from the Scheme. This does NOT mean PIB will NEVER be payable in these cases: if the applicant s condition deteriorates and with it their earning ability, or their income from a pension or social security payment stops, they can contact the Scheme administrators for a review of the claim. Once set, claimants PIB is only reviewed if the claimant s circumstances change. That means if: their social security benefits start or stop (but not if the payments change) they reach normal pension age their earning ability declines further and they ask for a review the claimant returns to NHS paid employment anywhere in the UK 11
Benefits example A person leaves the NHS after 7 years employment because of an injury or disease wholly or mainly attributable to their NHS duties. The Pensions Division s medical adviser assesses their permanent reduction in earning ability to be more than 25% and up to 50%. The best of their last 3 years pay was 20,000.00 a year. Using the table you can see that their potential income from the Injury Benefit Scheme would be calculated at 50% of the best of their last 3 years pay. So, 50% of 20,000.00 is 10,000.00 a year. This means that if their income, including their NHS pension and certain social security benefits (paid by the DWP), is less than 10,000.00 a year, the Scheme would pay the difference. The pension/benefits that form part of the allowance are as follows: NHS (or other public sector) pension / private pension / SERPS. Incapacity Benefit (paid by the DHSS) Industrial Disablement Benefit (paid by the DHSS) Damages / compensation If in the example above an NHS pension of 3,000.00 a year and various social security benefits adding up to 3,200.00 a year were in payment totalling 6,200.00 a year, PIB of 3,800 a year would be payable. With a permanent reduction of earning ability of more than 25% and up to 50% the lump sum shown on the table would be 25%. Based on a salary of 20,000.00 this would equate to 5,000.00 (25% of 20,000.00). The rates used to calculate benefits are the rates that applied on the date earnings were permanently reduced. This will be either the day someone stopped working or the day when they started lower paid employment. A lump sum is not payable if an individual moves to a lower paid job in the same employment. The PIB annual allowance may only be reviewed if social security benefits (paid by the DHSS) stop or start and will not be reviewed if the benefits are adjusted. 12
PIB and Social Security benefits People eligible for PIB may also be eligible for a range of social security benefits (paid by the DHSS). Income from these benefits is taken into account in the calculation of the annual allowance to be provided by the Injury Benefit Scheme. The PIB allowance will then be recalculated if and when social security benefits stop or start (but not if their level is adjusted). Relevant social security benefits are: Industrial Injuries Disablement Benefit - awarded if the accident is accepted by the DHSS as an industrial injury and there is a loss of faculty of 14% or more. Incapacity Benefit - awarded when Statutory Sick Pay has ended. 13
Damages and compensation If the applicant gets damages and compensation for the injury, these will be taken into account when the level of Injury Benefits awarded is assessed. This may mean paying back some or all of the NHS Injury Benefits received where compensation has also been received for the same injury. It may also reduce any future NHS Injury Benefits. If the applicant is claiming damages or compensation they should notify their legal advisor that they are claiming NHS Injury Benefits and draw their attention to the Scheme Regulations. Anyone claiming NHS Injury Benefits must inform the Pensions Division as soon as their damages (or compensation) claim is settled. 14
Who s covered? Almost all staff employed in the NHS are covered by the Scheme from their first day of work until their last day of employment and they do not have to be members of the NHS Pension Scheme. NHS employees covered by the Scheme include: An employee of the NHS is the Isle of Man GPs, Ophthalmic Practitioners, and Dental Practitioners working for the NHS Holders of NHS appointments approved by the Scheme Employees of certain other NHS organisations that have been approved by the Civil Service Commission to be covered by the Scheme (i.e. Hospice Employees) Who's NOT covered? GP practice staff, dental practice staff, freelance GP and dental locums and staff working for a private or public limited company that provides a service to the NHS (i.e. agency staff) are not covered by the Scheme. 15
Death benefits If a NHS employee dies in employment as a result of an injury or disease wholly or mainly attributable to their NHS duties or if, later in life, their death is hastened by an injury or disease sustained at work, their spouse and dependents may qualify for death benefits from the Scheme. The spouse must have been married to the deceased both at the time NHS employment ended and at the time of death. 16
Further information Where do I go for help? Your scheme administrator is the first place you should go for information about the NHS Injury Benefits Scheme and they can be contacted at the: Pensions Division St George s Court Myrtle Street Douglas ISLE OF MAN IM1 1EE Telephone 01624 685598 Fax 01624 685761 Email pensions@gov.im Website: www.gov.im/personnel If you require further details about the scheme rules, you should contact the scheme managers who are the: Civil Service Commission Goldie House 1-4 Goldie Terrace Douglas ISLE OF MAN IM1 1EB Telephone 01624 685000 Fax 01624 685736 17
How do I complain? If you have a problem with any part of your pension benefits, you should try to sort it out with the scheme administrator. Often, a phone call or an e-mail will be enough. If you cannot sort out the problem easily, you can ask them for a written explanation of their decision. If, after receiving the administrator s decision you still feel that you have a valid complaint, you (or someone representing your interests, such as a friend or trade union) can ask for your complaint to be passed on to the Secretary of the Civil Service Commission. Your complaint will be investigated and a determination will be issued. A copy of the Pensions Division Complaints procedure can be downloaded from the pension pages of their website www.gov.im/personnel The Pensions Advisory Service (TPAS) You may contact The Pensions Advisory Service (TPAS) at any time. TPAS help members and their beneficiaries of occupational schemes in connection with difficulties they have with the Trustees, Managers or Administrators of their scheme. You can write to TPAS at: 11 Belgrave Road London SW1V 1RB The Isle of Man Ombudsman If TPAS cannot sort out your problem, you can approach the IOM Pensions Ombudsman (based at the same address as TPAS). The IOM Pensions Ombudsman has the power to investigate and make decisions about complaints or disagreements of fact in law in relation to occupational pension schemes. The IOM Pensions Ombudsman can investigate any complaint but will expect you to have used TPAS before he will investigate the complaint himself. 18
Glossary of terms Abatement The PIB annual allowance is subject to a reduction if the individual returns to NHS paid employment anywhere in the IOM. Average remuneration Average remuneration for TIA is an individual s NHS pensionable pay up until the point that their pay reduced. Average remuneration for the purposes of PIB is the NHS pensionable pay up until the individual s NHS employment ceased. Average remuneration is based on pensionable pay (or what would have been pensionable pay) and does not include overtime or bonuses. Different rules apply when calculating the average remuneration for Practitioners. Criminal Injuries Compensation Scheme The Criminal Injuries Compensation Scheme is not linked to the NHS. It administers the Criminal Injuries Compensation Scheme 2005 to the Isle of Man. The CICS provides compensation to individuals who have suffered a criminal injury, which qualifies under the 1983, and 2005 Criminal Injuries Compensation Scheme. If NHS Injury benefits are awarded the CICS must be informed if they are considering a claim. Damages and compensation The Regulations allow for damages or compensation received by an individual to be taken into account when assessing the level of Injury Benefits to be awarded. This may mean that an individual will have to pay back some or all of their NHS Injury Benefits where they have also received compensation for the same injury. It may also reduce any future NHS Injury Benefits. An individual claiming damages or compensation should notify their legal advisor if they are claiming NHS Injury Benefits and draw their attention to Scheme Regulation 17. An individual claiming NHS Injury Benefits must inform the Pensions Division as soon as their damages (or compensation) claim is settled. Social Security Benefits (administered by The Department of Social Security) There are several social security benefits that count towards the annual income. These are: Industrial Injuries Disablement Benefit; awarded if the accident is accepted by the DHSS as an industrial injury and there is a loss of faculty of 14% or more. Incapacity Benefit; awarded when statutory sick pay has ended 19
Small print This booklet is a straightforward guide to the main conditions of the NHS Injury Benefits Scheme. It does not cover every area the full details are contained in the rules, which are the legal basis of the scheme. Nothing in this booklet can replace the rules, and if there is any difference, the rules will apply. This booklet is based on the rules current at the time of writing, and there is no guarantee that any part of the rules will not change in the future. Before we make changes to the rules, we discuss the changes with the NHS Unions. The taxation treatment of some events is mentioned throughout this booklet where considered helpful. It is intended as general advice only; there are many other issues and personal circumstances that can affect your tax affairs and no reliance should be placed on this booklet when making financial decisions The NHS Injury Benefits Scheme is a statutory arrangement. 20
Notes This booklet is published by the Civil Service Commission from information produced by NHS Business Service Authority UK and is intended for current members of the NHS Superannuation Scheme 2007, the NHS Pension Scheme 2008 and employees of the NHS in the Isle of Man. Crown Copyright. Issue 1 October 2008 21
This document can be provided in large print or audio tape on request Civil Service Commission c/o The Personnel Office Goldie House, 1-4 Goldie Terrace Douglas, Isle of Man IM1 1EB