Occupational Injuries Benefit - Incapacity Supplement


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Internal Guidelines used in processing claims

Table of Contents

PART 1: ENTITLEMENT
Description of Scheme
Information Leaflet
Legislation
Administration
- QUALIFYING CONDITIONS
- DISQUALIFICATIONS
Absence from the State
Conditions for continued receipt of payment
- Exemptions
- Back to Work Allowance
Back to Education
RATES STRUCTURE
- EXTRA BENEFITS
- OVERLAPPING PROVISIONS

PART 2: CLAIMS, INVESTIGATION AND DECISION PROCEDURES
Claims
Late Claims
- Compensation for Loss of Purchasing Power
Documentation
Investigation of claim
Decisions
Appeals

PART 3: PROCEDURES FOLLOWING AWARD
Payment
Duration of Payment
Continued payment on death
- Maintenance
Certification of ongoing entitlement
Review
Suspension of payment
Credits


PART 1: ENTITLEMENT

Description of Scheme

Incapacity Supplement is an increase to Disablement Pension where a person is considered to be permanently incapable of work as a result of an occupational accident/disease and does not qualify for another Social Welfare benefit such as Illness Benefit.

See also under Disablement Benefit.

Information Leaflet:

SW 31 - Disablement Benefit refers.

Legislation

The main legislation relating to Incapacity Supplement is contained in

Chapter 13 of Part II of the Social Welfare (Consolidation) Act, 2005 as amended,

S.I. No. 77 of 1967 as amended, (main regulations)

Administration

Disablement Section, Social Welfare Services Office, Ballinalee Road, Longford deals with claims for Incapacity Supplement.

QUALIFYING CONDITIONS
  • Person must be in receipt of a Disablement Pension
  • Person must be incapable of work for at least 6 months as a result of an occupational accident or disease.
  • Person must not qualify for another Social Welfare Benefit such as full rate Illness Benefit or Invalidity pension.
  • Person must not be in receipt of any other Social Welfare Benefit or Assistance (See below re Overlapping Payments for exceptions)
  • Person must not have earnings in excess of 23.00 per week.
DISQUALIFICATIONS

See Section on Disqualifications for Disablement Benefit. These also apply to Incapacity Supplement claims.

In addition, a person may be disqualified from receiving Incapacity Supplement for a period up to 9 weeks if s/he fails without good cause to comply with the conditions pertaining to the scheme.

Absence from the State

Incapacity Supplement is not payable when a person is absent from the State. However, an officer of the Department may decide on behalf of the Minister to allow Incapacity Supplement to be paid having regard to the circumstances of the case if the absence is for the specific purpose of receiving treatment for incapacity which commenced before the person left the State or the absence is for a period in respect of which Constant Attendance Allowance is payable.

Incapacity Supplement may be paid to a claimant in other EU member States in accordance with Council Regulation ( EC) No 1408/71, Chapter 4.

Conditions for continued receipt of Incapacity Supplement

The conditions which apply to recipients of Incapacity Supplement are as follows:

  1. Obey the doctor's instructions and answer any reasonable enquiries concerning his/her claim;
  2. Do not behave in a way which is likely to delay recovery;
  3. Leave word as to where s/he is when away from home;
  4. Do not unreasonably refuse to see an Inspector of the Department;
  5. He/she shall do no work unless it be work in respect of which his/her earnings do not, on the average, exceed 23.00 per week.
Exemptions

However a person may, with the prior written permission of an officer of the Minister, be exempted from the operation of condition No 5 (above) for any period during which -

  1. having become permanently incapable of following his/her usual occupation, s/he is undergoing a course of training with a view to taking up some other occupation,
  2. s/he is engaged in part-time work (ie. less than 20 hours a week) - no income limit applies which is in the nature of rehabilitation or occupational therapy.

Any Incapacity Supplement customer who wishes to obtain an exeption to participate in a FAS training course or in a CE scheme should contact his/her local FAS Office. All first-time requests for exemptions received through FAS will be granted automatically. Any subsequent request through FAS will be sent to one of the Department's Medical Advisors for advice which will be taken into consideration when determining if a further exemption should be granted. If a further exemption is refused and the customer queries the refusal the case is referred to the Chief Medical Adviser or the Deputy Chief Medical Adviser for a further opinion.

In all other cases, the application together with a recommendation from the person's GP and details of the proposed training/work are forwarded to a Medical Advisor and subsequently to the CMA or the DCMA as necessary as stated above.

During the period covered by the exemption, the customer will not be sent for medical examination by the Department's Medical Advisors for Incapacity Supplement purposes. Any medical examination due for Disablement pension purposes during the course of the exemption period will proceed on schedule.

Back to Work Allowance

Since June 2000, a person in receipt of Incapacity Supplement may apply to avail of the Back to Work Allowance which would be paid instead of the Incapacity Supplement. If, for any reason during the Back to Work period they are unable to continue working their Incapacity Supplement will be automatically restored. (See separate guidelines on " Back to Work Allowance" ).

Back to Education

From September 2000, a person in receipt of Incapacity Supplement may qualify for the Back to Education Programme. (See separate guidelines on " Back to Education" )

RATES STRUCTURE

Payment is made up of a personal rate and increases in respect of the person's spouse/partner and for each qualified child. (See separate guidelines on " Increases" ).

Rates of payment for Incapacity Supplement are contained in the SW 19.

EXTRA BENEFITS

A person in receipt of Incapacity Supplement may be entitled to a Fuel Allowance payable under the National Fuel Scheme. See separate guideline on " National Fuel Scheme" for qualifying conditions.

They may also qualify for a Living Alone Increase. See separate guideline on " Living Alone Increase " for full details. (See SW 19 booklet for current rate)

A person in receipt of Incapacity Supplement for one year or more may be entitled to the following extra benefits:

  • Free Travel
  • Electricity/Natural Gas/Bottled Gas refill Allowance
  • Free Television Licence
  • Telephone Rental Allowance

They may also qualify for an Increase for Living on a Specified Island which is payable if they are ordinarily resident on one of a list of specified islands off the coast of Ireland (It is paid automatically - there is no need to apply).

See ' Increase for Living on a Specified Island' guideline for more general information.

OVERLAPPING PROVISIONS

Incapacity Supplement may be paid at half the personal rate for up to 390 days to persons in receipt of any one of the following:

  • Death Benefit
  • Widow's/Widower's Contributory and Non-contributory Pensions
  • Deserted Wife's Benefit and Allowance
  • Prisoner's Wife's Allowance
  • Lone Parent's Allowance
  • One Parent Family Allowance

Periods before the award of Incapacity Supplement, during which both Illness Benefit and one of the above payments were received, are counted towards the calculation of the 390 days for this purpose.

Exception:

A person who was in receipt of Incapacity Supplement and one of the above payments on 5 April 1990 retains entitlement to Incapacity Supplement until the end of the period of incapacity for work.

PART 2: CLAIMS, INVESTIGATION AND DECISION PROCEDURES

Claims

The Department invites persons on Disablement Benefit to claim Incapacity Supplement where a possible entitlement exists. When a Deciding Officer is deciding a Disablement Benefit claim s/he checks out if the person is incapable of work due to the occupational injury based on a Medical Assessor examination report and if s/he qualifies and is in receipt of another Social Welfare Benefit, e.g. Illness Benefit. Where the person does not qualify for such a Benefit or is in receipt of a reduced rate of benefit only the Deciding Officer makes arrangements for a Claim Form for Incapacity Supplement to be sent to the person.

Incapacity Supplement is claimed on Form OB 21.

Late Claims

A person is disqualified for payment for any period more than 3 months prior to the date of claim. However, the claim can be backdated and payment made in respect of a period of up to 6 months prior to the date of the claim, where the person can prove to the satisfaction of the Deciding Officer or Appeals Officer that he/ she satisfied the qualifying conditions during that period and that there was good cause for the delay in making the claim throughout that period.

Further backdating of payment may also be possible on an extra-statutory basis in respect of late claims made prior to 25 May 2000 and, where late claims made on or after 25 May 2000 are concerned, in accordance with the provisions of Statutory Instrument 159 of 2000, Social Welfare (Consolidated Payments Provisions)(Amendment)(No.8)(Late Claims) Regulations, 2000.

See " CLAIMS AND LATE CLAIMS" guideline for further information on late claims and all the circumstances in which backdated payments or allowances may be made.

Compensation for Loss of Purchasing Power

Compensation for loss of purchasing power may be paid where there is an inordinate delay, attributable to the Department, in deciding a claim which results in the claimant receiving an amount of arrears that is worth less because of inflation.

See " CLAIMS AND LATE CLAIMS" guideline for information on the circumstances where compensation for loss of purchasing power is payable and how it is calculated.

Documentation

A person claiming Incapacity Supplement is responsible for the production of certificates, documents, information and other evidence required. This may include Birth Certificates, details from school/college for children over 18, means details, i.e., P60 or current payslip. Incapacity Supplement cannot be awarded until all necessary documentation has been provided.

Investigation of claim

The information required regarding disablement will in most cases be available in the Disablement Benefit file. In cases of doubt it may be necessary to refer a person for a Medical Assessor examination in respect of Incapacity Supplement or to send his/her medical papers to the Department's Medical Advisor for consideration prior to a decision being made.

When all the documentation necessary to make a decision on a claim has been received, the file is referred to a Deciding Officer for decision.

Decisions

Claims are decided by Deciding Officers appointed by the Minister under Section 299 of the Social Welfare (Consolidation) Act, 2005. A notification of the decision is issued to the claimant. When claims are disallowed or allowed at reduced rates the person is given an explanation of the reason for the disallowance or partial award. When Incapacity Supplement is awarded a list of conditions is issued with the notification. The person is also instructed to send in monthly medical certificates in respect of his/her incapacity for work.

Appeals

A person who is refused Incapacity Supplement or who is awarded a reduced rate of payment may appeal the decision to the Chief Appeals Officer.

PART 3: PROCEDURES FOLLOWING AWARD

Payment

Incapacity Supplement is paid in addition to Disablement pension.

See separate guideline on Disablement Benefit.

Duration of Payment

Incapacity Supplement is payable as long as the person satisfies the qualifying conditions, except where the person is awarded another benefit which is not payable in conjunction with Incapacity Supplement (See Overlapping Provisions) or is no longer resident in the State.

Continued payment on death

Where an increase for a qualified adult or a qualified child is in payment the full rate of Incapacity Supplement will continue for a period of 6 weeks after the death of the insured person. If an increase for a qualified adult is not payable because the spouse/partner is in receipt of an Old Age or Blind Pension (non-contributory), then payment may also be made for 6 weeks after death.

If a qualified child dies the amount of the increase is payable for 6 weeks after the date of death.

However, if a qualified adult dies the amount of the increase in respect of him/her is not payable after his/her death.

Maintenance

See separate guideline on Disablement Benefit. Stop dates are inserted in the Department's payment system as appropriate, e.g., to withdraw an Increase for a Qualified Child when a child reaches 18 or at the end of the academic year in which the child reaches age 22, as the case may be.

Certification of ongoing entitlement

The onus is on the individual to notify the Department of any changes in his/her circumstances or to his/her household circumstances. Monthly medical certificates must be submitted to the Department by persons in receipt of Incapacity Supplement.

Review

Periodic reviews are carried out to confirm that the qualifying conditions continue to be fulfilled.

Suspension of payment

Where a question arises as to whether the conditions for the continued receipt of Incapacity Supplement are fulfilled, and initial enquiries fail to establish entitlement, payment may be suspended in whole or in part until the question has been determined.

This will be done if there is reason to believe that:

  • either the person, qualified adult or child is no longer alive;
  • the person is not resident at the given address;
  • the person has taken up employment or self-employment of a non-rehabilitative nature;
  • the earnings of the qualified adult have increased and claimant has failed to provide the requested details within a reasonable period of time.
Credits

Credits are awarded to recipients of Incapacity Supplement in certain circumstances. (See separate guidelines on Credits and on Illness Benefit)


Last modified:29/06/2010
 

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