Partial Capacity Benefit


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(February 2012)

PART 1: ENTITLEMENT
Description of Scheme
Information Leaflet
Legislation
Administration
Qualifying Conditions
Requalification after expiry of Partial Capacity Benefit
Conditions while receiving Partial Capacity Benefit

PART 2 CLAIMS, INVESTIGATION AND DECISION PROCEDURES
Claims
Certification
Decisions

PART 3: PROCEDURES FOLLOWING AWARD
Payment
Payment method
Maintenance
Over 65 and over 66 years
Medical Referral Assessments
Payment while on holidays or abroad
Change of circumstances
Appeal Credits
Special payment arrangements

PART 4: GENERAL PROVISIONS THAT APPLY TO THE SCHEME
Payment to appointed persons
Overpayments
(a) Procedures for recovery of overpayment
(b) Determining level of recovery, right of appeal
(c) Method of recovery
(d) Appeal


PART 1: ENTITLEMENT

Description of Scheme

Partial Capacity Benefit is a payment made to insured people after a Medical Assessor of the Department assesses their restriction on their capacity for work.

Information Leaflet/Guide

Department Website: 'www.welfare.ie'

Leaflet: Partial Capacity Benefit SW 132

Legislation

Social Welfare and Pensions Act 2010

The main provisions relating to Partial Capacity Benefit are contained in

Social Welfare (Consolidated Claims, Payments and Control) (Amendment) (No. 2) (Partial Capacity Benefit) Regulations 2012.

Administration

Partial Capacity Benefit Section, Floor 2, Áras Mhic Dhiarmada, Store Street, Dublin 1 deals with all claims for Partial Capacity Benefit.

Qualifying Conditions

To qualify for Partial Capacity Benefit a person needs to be currently in receipt of either:

  • Illness Benefit ( for a minimum of 6 months),
    or
  • Invalidity Pension.

A Medical Assessor of the Department will assess the restriction on their capacity for work. This may require them to attend a medical assessment. They should include all appropriate medical evidence with their application. They will qualify for Partial Capacity Benefit if the restriction on their capacity for work is assessed as moderate, severe, or profound. If it is assessed as mild they will not qualify and their continued eligibility to Illness Benefit or Invalidity Pension will also be reviewed. If they qualify for Partial Capacity Benefit, they will not be required to send in medical certificates.

Be under 66 years

To be entitled to Partial Capacity Benefit a person must be under pensionable age (currently 66 years) on the day for which benefit is claimed. Persons approaching pensionable age are advised to apply for State Pension (Contributory/Non-Contributory) 3 months in advance.

Disablement Benefit and PCB

If you are getting Disablement Benefit you may also qualify for Partial Capacity Benefit if you have some capacity for work and satisfy the PRSI and medical conditions, provided that the Disablement Benefit payment does not include an increase for Incapacity Supplement.

Duration of Payment

Partial Capacity Benefit payment will last as long as the recipient has an underlying entitlement to payment of Illness Benefit or Invalidity Pension.

Increases for Qualified Adult/Qualified Child

The conditions for payment of an increase for a qualified adult and/or qualified child(ren) remain the same as those that applied to the Illness Benefit or Invalidity Pension claim.

Requalification after expiry of Partial Capacity Benefit

A person who qualifies for Partial Capacity Benefit having previously been on Illness Benefit and who exhausts entitlement to Illness Benefit during the period of entitlement to Partial Capacity Benefit can continue to be entitled to Partial Capacity Benefit by virtue of being deemed to satisfy the conditions for Invalidity Pension.

Conditions while receiving Partial Capacity Benefit?

A person may be disqualified from receiving Partial Capacity Benefit for a period of up to 9 weeks if the person fails without good cause to comply with such requirements as may be specified by the regulations.

  1. Fail, without good reason, to attend a medical assessment by a Medical Assessor of this Department.
  2. Fail to see any officials from this Department and answer reasonable enquiries concerning their claim.
  3. Fail to obey their doctor's instructions.

PART 2 CLAIMS, INVESTIGATION AND DECISION PROCEDURES

Claims

Claims for Partial Capacity Benefit are made on form PCB 1.

The claim form should be submitted to:

Partial Capacity Benefit Section
Department of Social Protection
Floor 2
Áras Mhic Dhiarmada
Store St
Dublin 1.

Certification

No medical certificates are required for Partial Capacity Benefit.

Decisions

All claims to Partial Capacity Benefit are examined by a Deciding Officer.

If a Deciding Officer disallows a claim to Partial Capacity Benefit, the customer must be informed of all the reasons that the claim to Benefit is being disallowed.

A person who is not satisfied with the decision of the Deciding Officer on his/her claim may appeal the decision to the independent Social Welfare Appeals Office within 21 days of the date of the decision. In advance of an appeal the customer can seek a review of the decision by another Deciding Officer.

( See Appeal Submission Guidelines)

PART 3: PROCEDURES FOLLOWING AWARD

Payment

Partial Capacity Benefit is paid weekly in arrears. There is no fixed date of payment. Sunday is not counted for payment purposes.

Payment method

Payment is made by Electronic Funds Transfer (EFT) directly into a Bank or Building Society account.

Maintenance

Stop/Review dates are inserted in the computer system for appropriate dates e.g. person reaches pension age, qualified child reaches 18 years of age, review of earnings for spouse/partner, etc.

Over 65 and over 66 years

Claimants are advised in writing 3 months before their 65th birthday, to apply for State Pension (transition) and 3 months before their 66th birthday to apply for the State Pension (Contributory/Non Contributory).

Claim forms for above pensions issue with the advice letter to claimants. When the claimant reaches 66 years of age, payment is ceased as s/he has exhausted his/her entitlement to benefit.

Medical Referral Assessments

During the course of a claim to Partial Capacity Benefit, a person may be asked to attend for a medical assessment by a Medical Assessor of the Department. (See separate guideline on Medical Assessments).

The opinion of the Medical Assessor following this assessment is submitted to a Deciding Officer for consideration regarding the claimant's continued entitlement. In any case where payment of Partial Capacity Benefit is disallowed, the person is notified of the decision and advised of his/her right to appeal against the decision.

Payment while on holidays or abroad

Overall, a person going to an EEA Member State is entitled to be treated as if s/he never left the State, regardless of the reason for leaving the State.

A person who wishes to go to a non- EEA country for health reasons, may be entitled to Partial Capacity Benefit for the duration of his/her absence. While each case is treated on its own merits, a decision would take into account factors such as duration of claim at time application is received, nature of incapacity and likely period to be spent abroad.

In any event the person must notify the Department in advance of departure and is paid for the period of absence on his/her return.

Change of circumstances

Any change in circumstances should be notified to the Department immediately.

Partial Capacity Benefit Appeal Credits

(See separate guideline on " PRSI - Credited Social Insurance Contributions"). Where a person has been disallowed Partial Capacity Benefit and appeals that decision, credits are awarded up to the end of the week following that in which the Appeal Officer's decision issued to him/her.

Special payment arrangements

Special arrangements can be made, where necessary, to ensure that the spouse and the children of a claimant get a portion of the weekly payment paid directly to them. Where a claimant claims for a qualified adult increase in respect of a spouse or partner who is not living with him/her, a questionnaire may issue to the spouse/partner to obtain details in relation to income from employment/Social Welfare payment, maintenance being paid by claimant, whether support is voluntary or under Court Order, etc.

PART 4: GENERAL PROVISIONS THAT APPLY TO THE SCHEME

Payment to appointed persons

Social Welfare Consolidation Act 2005, Section 244 & S.I. 142 of 2007 Sections 201 - 208 refer

Where a claimant requests that payment issues to a person other than him/herself, the name being used for payment purposes may be changed. For all cases, other than where a person is in hospital, a submission is made to an Higher Executive Officer outlining the reason for this change in procedure and, where appropriate, requesting a decision as to whether a proposed medical assessment referral should be deferred and if so, for what period.

Overpayments

Social Welfare Consolidation Act 2005, Section 335 & S.I. 142 of 2007 Sections 242 - 249

Regulations provide for a Code of Practice on the Recovery of Overpayments. The Code specifies the circumstances in which this Department may or may not pursue repayment of monies by a customer who was overpaid benefit. A copy of the Department's Information Leaflet on the Code (leaflet SW 2) is issued to the claimant when s/he is being notified of the overpayment relating to the Partial Capacity Benefit scheme.

(a) Procedures for recovery of overpayment

In advance of an overpayment being assessed, the Department applies the principle of natural justice and advises the customer how the overpayment has arisen and inviting him/her to submit comments before a formal decision on the overpayment is made.

Fourteen days are allowed for a reply to be received. Where there is no reply or the reply does not alter the case, the overpayment is formally assessed against the person. Forms or a decision letter are/is issued to inform the customer of the amount of the overpayment and the intended level and method of recovery, giving the right of appeal.

Details of the overpayment and the recovery method as determined by the Deciding Officer are recorded with the claim.

(b) Determining level of recovery, right of appeal

When deciding on the level of recovery, regard is had to the financial and family circumstances of the customer. The Deciding Officer does not normally reduce the customer's weekly payment below the Supplementary Welfare Allowance (SWA) level as it is accepted by the Department that customers are entitled to a minimum level of income. However, where the customer's spouse has other income (e.g. from employment or other SW payment) then SWA level does not have to be applied.

(c) Regarding the method of recovery the following methods may be used

  1. withholding arrears which may be due to the customer,
  2. making deductions from ongoing or future payments,
  3. a single payment to repay the overpayment in full,
  4. weekly repayments,
  5. seek recovery of overpayment from an employer (where appropriate *). *an example, would be where overpayment arose through concurrent working and claiming and the employer was obliged to and failed to notify the Department of the commencement of employment.
  6. seek recovery by requesting the social security institution of another Member State of the EEA to deduct the amount of Irish Partial Capacity Benefit overpaid from the amounts of benefits which it is responsible to pay. The social security institution of another Member State of the EEA makes the deductions under the conditions and within the limits provided for the setting off of benefits under its own legislation and treats the Irish overpayment as if the sum had been overpaid by itself and transfers the amounts deducted to this Department. (The rule also applies in reverse - social security institutions of other Member States of the EEA can seek recovery of overpayments from our Partial Capacity Benefit). See Article 111 of Council Regulation (EEC) No. 574/72.
  7. where a person was paid social assistance by the social security institution of another EEA Member State during a period when s/he was entitled to Partial Capacity Benefit under our legislation, the institution which gave the assistance may request the Department to deduct the amount of assistance from the amount of Partial Capacity Benefit which the Department pays. The institution requesting recovery must be legally entitled to reclaim the benefits from the person concerned.

(d) Appeal

Where the customer lodges an appeal to the independent Social Welfare Services Appeals Office (within 21 days) against the decision to set up an overpayment, the Deciding Officer suspends further recovery action until the appeal has been decided. If a late appeal is accepted after 21 days has elapsed and the recovery procedure is already in place then the recovery continues pending the outcome of the appeal.

The date of receipt of an appeal relating to Partial Capacity Benefit by an authority, institution or tribunal in another Member State of the EEA which should have been submitted to the Social Welfare Services Appeals Office is treated as the date of receipt of an appeal by the latter. The authority, institution or tribunal in another Member State of the EEA sends the appeal without delay to Ireland.

Last modified:16/02/2012