Illness Benefit


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Internal Guidelines: Illness Benefit

Index

PART 1: ENTITLEMENT

Description of Scheme
Information Leaflets/Guide
Legislation
Administration
Qualifying Conditions in Summary
Qualifying Conditions in Detail
Linking
Waiting Days
Linking Provisions for Certain Illness Benefit Claims
Rates of payment
Determining Average Weekly Earnings
Volunteer Development Workers
Night workers
Payments to Persons in Receipt of certain Social Welfare Payments
Payments to Persons in Receipt of Carer's Benefit or Allowance
Blind Pension
Overlapping entitlements to Illness Benefit and certain pensions or benefits from other countries
Taxation of Illness Benefit
Increases for Qualified Adult/Child
Extra Benefits
Civil & Public Servants recruited on or after 6th April 1995
Sharefishermen/women
Duration of Payment
Requalification after expiry of Illness Benefit
JB/JA Payable Pending Illness Benefit Appeal
Pregnancy
Certain IB Incapacities which are accepted/refused for IB purposes
Defence Forces
Disqualifications
Imprisonment
Trade Dispute
Penalty for false or misleading information
Payment after death

PART 2 CLAIMS, INVESTIGATION AND DECISION PROCEDURES

Claims
Certification
Intermediate Certificates
Late Claims
Decisions
Illness Benefit/Disability Allowance customers
Pre-Entry Credits (PECs)
Student Credits

PART 3: PROCEDURES FOLLOWING AWARD

Payment
Payment method
Maintenance
Frequency of certification
Over 65 and over 66 years
Stop Dates
Medical Referral Assessments
Payment while on holidays or abroad
Incapacity Gap
IB Appeal Credits
Health and Safety Benefit - Implications for payment of Illness Benefit
Special payment arrangements
Assessment of Damages in Civil Cases

PART 4: GENERAL PROVISIONS THAT APPLY TO SCHEME

Previously Found capable
Payment to appointed persons
Overpayments
Conditions while receiving Illness Benefit


PART 1: ENTITLEMENT

Description of Scheme

Illness Benefit is a payment made to insured people who are unable to work due to illness and who satisfy certain PRSI contribution conditions.

Information/Leaflets/Guide

Department Website: www.welfare.ie

Email using Illness Benefit Enquiry Form

Leaflets:

Illness Benefit - SW 119

Illness and Occupational Injury Benefit Late Claims – possible further payments - SW 101

'The Community Provisions on Social Security - Your rights when moving within the European Union' (Published by the European Commission). Available for free download.

Legislation

The main provisions relating to Illness Benefit (formerly Disability Benefit prior to 2/10/2006) are in:-

Part 2 - Chapter 8 (Sections 40 to 46) of the Social Welfare (Consolidation) Act, 2005 Number 26 of 2005, as amended

and

Part 2 - Chapter 1 (Articles 20 to 28) of Social Welfare (Consolidated Claims Payments and Control) Regulations, 2007 (S.I. no. 142 of 2007) as amended

Regulations (EEC) No. 883/04

Regulation (EEC) No. 987/09

Administration

Illness Benefit Section, Áras Mhic Dhiarmada, Store Street, Dublin 1 administers claims for Illness Benefit. It also forwards claims which are proper to another Member State of the European Economic Area (EEA) to the relevant Member State.

Qualifying Conditions In Summary

To qualify for Illness Benefit (IB) a customer must:

  • Be unable to work due to illness
  • Be under the pensionable age (currently 66)
  • Satisfy the contribution conditions

QUALIFYING CONDITIONS IN DETAIL

Be unable to work due to illness

Illness Benefit is paid for each day on which a customer is unable to work due to illness. In legislation this day is defined as a "day of incapacity for work". Any 3 days of incapacity for work, whether consecutive or not, within a period of 6 consecutive days are treated as a period of incapacity for work and any 2 such periods, not separated by more than 3 days, are treated as one period of incapacity for work.

How this is applied is explained further in the sections "Linking" and "Waiting Days".

Be under the pensionable age (currently 66)

A customer may receive IB up to the day before their 66th birthday. Customers approaching pensionable age should apply for State Pension (Contributory/Non-Contributory) 3 months in advance.

Satisfy the contribution conditions

To qualify for IB a customer must satisfy all 3 of the contribution conditions which are detailed here. Please note the following points:

  • The tax year is from the 1st January of each year to the 31st December in the same year.
  • The relevant tax year is the second last complete tax year before the year in which the claim for Illness Benefit begins. For example:
    • if a claim begins in 2012 the relevant tax year is 2010
    • if a claim begins in 2013 the relevant tax year is 2011
    • if a claim begins in 2014 the relevant tax year is 2012
    • if a claim begins in 2015 the relevant tax year is 2013 
  • The relevant tax year is sometimes referred to as the governing contribution year (GCY).
  • Only PRSI contributions paid at Class A, E, H or P are reckonable for IB.
  • There are 2 ways of satisfying the second condition (2a or 2b)
First contribution condition

1) From 5th January 2009 a customer must have at least 104 (previously 52) reckonable contributions paid since they first started insurable employment.

Second contribution condition

2a) a customer must have at least 39 reckonable contributions paid or credited in the relevant tax year and 13 of these contributions must be paid contributions. If a customer does not have 13 contributions paid in the relevant tax year then 13 paid in one of the following tax years can be used:

  • either of the two tax years before the relevant tax year
  • or the last complete tax year (before the year in which the claim for Illness Benefit begins)
  • or the current tax year.

OR

2b) a customer must have 26 reckonable contributions paid in the relevant tax year and 26 weeks PRSI paid at the appropriate class in the tax year immediately before the 'governing contribution year'.

Third contribution condition

3) A customer must have average reckonable weekly earnings above a certain amount in the relevant tax year. Reckonable weekly earnings for this purpose are earnings from employment which was insured only at PRSI class A, B, C, D, E, H, J and P.

The amount of a customer's average reckonable weekly earnings in the relevant tax year determines the rate of Illness Benefit payable.

Reckonable weekly income is used where a customer qualifies having paid optional contributions.

See section 'Rate of Payment' for details of current rates.

Customers who are exempt from some of the contribution conditions outlined above

First contribution condition (1 above)

  • A customer whose IB claim commences on or after 5 January 2009 that is not separated by more than 26 weeks (in other words the same period of interruption of employment) from a previous paid Illness Benefit, Occupational Injury Benefit, Jobseeker's Allowance, Jobseeker's Benefit, Maternity Benefit or Invalidity Pension claim, which commenced prior to 5 January 2009, will only require 52 paid PRSI contributions since starting work. The previous claim must be for a period of at least 3 days.

13 paid contributions requirement (2a) above)

  • This requirement was introduced on 1 July 1992. A customer who was receiving Illness Benefit (then called Disability Benefit) on that date and who stopped claiming, does not need to satisfy this requirement if they renew their claim to IB within the same period of incapacity (in other words the claims are not separated by more than 3 days).
  • A customer who was receiving Jobseeker's Allowance, Pre-Retirement Allowance (before 4 July 2007 only), Invalidity Pension, Carer's Allowance or Carer's Benefit, immediately before claiming Illness Benefit, does not need to have the 13 paid contributions referred to above. However, where there are no reckonable earnings in the relevant tax year, the customer only qualifies at a reduced rate of payment.

Average reckonable weekly earnings in the relevant tax year (3 above)

(i) Legislation introduced on 1 May 2007 provides for the following:

  • That for a customer who was in receipt of Illness Benefit for a period of two years or more (624 paid days or more) and stopped claiming IB (e.g. if they returned to work), then subsequently claims IB and both claims are not separated by more than 26 weeks
    • payment will be made at a rate not lower than the customer previously received on IB
    • there is no requirement to serve waiting days (see below)

(ii) A customer who was in receipt of Illness Benefit, then transferred immediately to Back To Work Allowance, Back To Education Allowance, Carer's Benefit, Carer's Allowance or Invalidity Pension and subsequently returns immediately to IB (in other words the claims are not separated by more than 3 days so same period of incapacity applies) is entitled to payment at a rate not lower than the customer previously received on IB.

(iii) A customer who was in receipt of long-term Jobseeker's Allowance (paid for at least 390 days) at the maximum payment rate and immediately claims Illness Benefit (in other words both claims are not separated by more than 3 days) is entitled to payment of IB at the maximum rate.

(iv) A customer who was in receipt of Occupational Injury Benefit (OIB) and immediately claims IB (in other words both claims not separated by more than 3 days – same period of incapacity) can use earnings from either the relevant tax year for the OIB claim or the relevant tax year for the IB claim to determine the rate of payment. The more beneficial of the 2 applies.

Using relevant periods in other Member States of the European Economic Area (EEA) where a person has insufficient Irish contributions

Periods of insurance, employment and residence in another EEA country may be used to help satisfy the contribution conditions for Illness Benefit if the person is within the scope of the EU provisions and not entitled by using the Irish record only. The EEA State(s) in which the person worked will provide, on request, details of such periods which can be taken into account.

The Department can take periods of employment in another EEA country into account when determining entitlement to Illness Benefit. In order to do so the person (see note below) must have last worked in Ireland and paid PRSI at the appropriate class (i.e. Class A, E, H or P) or would have paid PRSI at the appropriate class but for the application of the PRSI free allowance for employees. The Department is also responsible for aggregation where a claimant was in receipt of Irish Jobseeker's Benefit immediately prior to claiming Illness Benefit.

Note: The person must be an EEA national or have the official status of a stateless person or refugee residing in Ireland and have been subject to the social security legislation of another Member State of the EEA as an employed or self-employed person.

Community Employment Schemes

Community Employment (CE) Schemes are funded by the Department of Social Protection, but those taking part are treated as employees of the individual CE Scheme. Grant aid is provided to fund wages for participants in CE Schemes for 7 full days paid sick leave (or 14 half days for part-time staff) for medically certified periods.

A change announced in Budget 2012 means that a customer cannot receive payment of Illness Benefit (IB) and a Community Employment Scheme payment at the same time.

A customer who applies for Illness Benefit must provide details, to this Department, of payments made by the CE Scheme during periods of sick leave.

If that customer has no entitlement to Illness Benefit because they are paid full rate by the CE Scheme for the same period they are claiming IB, a form will issue to the customer advising them of this.

If the customer is no longer getting paid sick leave by the CE Scheme they can receive payment of IB for the duration of the illness.

A customer who is currently in receipt of IB and then starts employment on a CE Scheme is no longer entitled to IB once they start working with the CE Scheme.

Linking

A customer is entitled to IB in respect of any 'day of incapacity' for work which forms part of a 'period of interruption of employment'.

A day is not treated as a day of incapacity for work unless on that day the customer is incapable of work.

A 'day of interruption of employment' means a day which is a day of incapacity for work or of unemployment.

Any 3 days of interruption of employment, whether consecutive or not, within a period of 6 consecutive days are treated as a period of interruption of employment. Any two such periods not separated by a period of more than 26 weeks are treated as one period of interruption of employment.

Any 3 days of incapacity for work, whether consecutive or not, within a period of 6 consecutive days are treated as a period of incapacity for work and any two such periods not separated by more than 3 days are treated as one period of incapacity for work.

Neither Sunday nor paid holiday leave are treated as a day of incapacity for work while any two periods of incapacity for work separated by a period of paid holiday leave are treated as one period of incapacity for work. A customer who was in receipt of Maternity Benefit on any of the 3 days prior to the day in respect of which a claim for Illness Benefit is made is not entitled to payment of Illness Benefit for the first 3 days of incapacity.

Waiting Days

From 06 January 2014 a customer is not entitled to Illness Benefit for the first 6 days of any period of incapacity for work. (This increased from 3 days, following a change announced in Budget 2014).This means that a person does not get paid for the first 6 days that they are out sick. These are called "waiting days". Sunday is not counted as a waiting day.

Where a customer attends their place of employment for work purposes and subsequently goes home sick at any time, this day is not counted as a waiting day i.e. it is not treated as a day of incapacity for work.

However, where not more than 3 days have elapsed between a previous claim for Illness Benefit, Occupational Injury Benefit, Invalidity Pension, payment will issue from the first day i.e. no "waiting days" arise. Claims with a commencement date before 6 January 2014 and those coming from Maternity Benefit will not be paid for the first 3 days of illness.

Customers in receipt of Jobseeker's Benefit or Allowance:

Budget 2014 introduced a significant change in the way that customers who were recently in receipt of either Jobseeker's Benefit or Allowance (JB/JA) are to be authorised and those who are also in casual employment with an attachment to JB/JA.

When an Illness Benefit claim is made within 14 days of either a JB/JA claim such customers are exempt from serving waiting days. Previously this only applied to claims made within 3 days of a Jobseeker's claim.

From 6th January 2014, where the customer is coming from JB/JA within 14 days immediately prior to a new Illness Benefit or OIB claim, waiting days will not be served on the new claim.

Where a customer is coming from Jobseeker credits the same applies i.e. no waiting days.

Rate of payment

The maximum rate of Illness Benefit is payable where the customer satisfies the contribution conditions and has 'average weekly reckonable earnings' equal to or greater than a prescribed amount (currently €300.00) in the relevant tax year. Where the customer's average weekly earnings are less than the prescribed amount (ie. €299.99 or less) a reduced rate is payable which is determined by reference to the appropriate earnings band.

Exception to the current prescribed amount of earnings:

  • Prior to 5 January 2009 a customer required average weekly reckonable earnings of €150 or more in the relevant tax year to qualify at the maximum rate. Otherwise a customer qualified for payment at a reduced rate.
  • From 5 January 2009 a customer requires average weekly reckonable earnings of €300 or more in the relevant tax year to qualify at the maximum rate. Otherwise a customer will qualify for payment at a reduced rate.
  • If a customer makes a claim for IB which is not separated by more than 26 weeks (in other words the same period of interruption of employment) to a previous paid Illness Benefit, Occupational Injury Benefit, Jobseeker's Benefit, Jobseeker's Allowance or Maternity Benefit claim which started prior to 5 January 2009 that customer only requires average weekly reckonable earnings of €150 or more in the relevant tax year to qualify at the maximum rate (that is the pre 5 January 2009 earnings bands apply).

Reckonable weekly earnings for this purpose are earnings derived from employment which was insured at PRSI Class A, B, C, D, E, H, J and P.

Rates of payment are set out in the information booklet SW19 ('Social Welfare Rates of Payment' for the relevant year).

Determining Average Weekly Earnings

Average Weekly Earnings are calculated by dividing the total reckonable gross earnings (i.e. without deductions) in the relevant tax year by the actual number of weeks worked in that year.

Example:

Reckonable Earnings in relevant tax year = €16,800
No of weeks of work = 35
Average Weekly Earnings = €480.00

If a customer only worked one week in that year and earned €232.36 for that week, their reckonable weekly earnings would be €232.36.

Where a customer had average weekly earnings of less than €150.00 in the relevant tax year, a reduced rate of IB is payable.

Where a claimant has worked in another Member State of the EEA during the relevant tax year, a "notional" amount of earnings is credited in respect of each week of employment. This notional amount is equivalent to the average weekly earnings in that year for male and female workers in all industries as measured by the Central Statistics Office.

The average weekly earnings for the past few years are as follows:

 

Year Average weekly earnings
2010
€701.93 (for use on claims in 2012)
2011
€697.65 (for use on claims in 2013)
2012
€691.74 (for use on claims in 2014)
2013
€688.78 (for use on claims in 2015)

In cases where the person concerned had periods of employment in both Ireland and another EU member state in the relevant tax year (and their average weekly earnings in Ireland during that year were less than €300 a week), Deciding Officers should calculate the average weekly earnings based on both their earnings in Ireland and the “notional” EU earnings for the year in question (as set out above).

Volunteer Development Workers

There are special provisions for a customer claiming IB having been a Volunteer Development Worker (VDW) in a developing country.

From 21 December 1993, Volunteer Development Workers who worked abroad for an organisation which was affiliated to the Agency for Personnel Services Overseas (APSO) did not require reckonable weekly earnings of a prescribed amount to qualify for full rate IB in respect of certain IB claims made on their return.

In effect, this meant that full rate IB was paid in such cases for:

  1. all IB claims made during the benefit year in which they returned to Ireland and
  2. all IB claims made in the two succeeding benefit years,

provided that all other qualifying conditions were satisfied.

Night workers

Special rules apply to determine which day is to be treated as a day of employment where a customer is employed to work continuously from one day into another. These apply so as to ensure that both days are not treated as days of employment or as days of incapacity.

The general principle is that the day on which the shorter number of hours are worked is treated as a day of incapacity (in respect of which IB is payable) and the other day is regarded as a day of employment (in respect of which IB is not payable).

There are exceptions to this rule as follows:

The shift starts on a Saturday and extends into Sunday:

Saturday is considered to be the day of employment regardless of the number of hours actually worked on the Saturday.

The shift starts on a Sunday and extends into Monday:

Monday is considered to be the day of employment regardless of the number of hours actually worked on the Sunday.

Payments to Persons in Receipt of certain Social Welfare Payments
(see also section on Payments to Persons in Receipt of Carer's Benefit /Allowance and Blind Pension)

From 1 February 2012 Illness Benefit (IB) is no longer payable if a customer is also getting any of the following payments at the full rate:

  • Widow's/Widower's and Surviving Civil Partners Pensions, which includes Occupational Widow's/Widower's Pension
  • One-Parent Family Payment, which includes Deserted Wives Benefit, Deserted Wives Allowance and Prisoner's Wives Allowance

However, if a customer is getting a reduced rate of any of the above payments they may also get a reduced rate of IB, so that the combined amount of both payments is not greater than the rate of IB to which they are entitled.

This change does not affect the customer's entitlement to claim Credited Contributions, to maintain the continuity of their PRSI record, while they are unable to work due to illness.

Prior to February 2012 Illness Benefit was payable to customers who claimed Illness Benefit and who were in receipt of any of the above SW payments.

Where the customer was entitled to the full rate of pension or allowance, half the personal rate of IB only was payable for up to 15 months. No increase was payable for any qualified child.

Payments to Persons in Receipt of Carer's Benefit or Allowance

From 27 September 2007 a customer who is in receipt of Illness Benefit or being claimed for as a Qualified Adult and who is providing full time care to another person may apply for Carer's Allowance and retain their current payment in full. If they satisfy the conditions for Carer's Allowance it will be awarded at 50% of the personal rate they would qualify for if they were not in receipt of any other payment. They will also be eligible for Household Benefits and a Free Travel Pass.

Illness Benefit is not payable with Carer's Benefit.

Blind Pension

Full rate Illness Benefit may be paid to customers who are in receipt of a Blind Pension. Where a claimant to Illness Benefit is also in receipt of a Blind Pension, the personal rate and qualified adult and qualified child increases (where appropriate) for both Illness Benefit and Blind Pension are payable.

Overlapping entitlements to IB and pensions or benefits from other countries

Social Welfare legislation allows for payment of full-rate Illness Benefit with a pension for survivors from another EEA Member State or a country with which Ireland has a bilateral social security agreement.

Where a customer is in receipt of a Pro-Rata Pension from this Department based on a combination of contributions from this country and relevant periods in another EEA country or a country with which Ireland has a bilateral social security agreement payment of full-rate Illness Benefit is not allowed. However, reduced rate Illness Benefit may be payable.

Where a person covered by EU legislation is entitled to claim Illness Benefit under the legislation of Ireland or Short-Term Incapacity Benefit under the legislation of the UK for the same period of incapacity for work, then benefit is only due from this Department if the person last paid Irish social insurance contributions at the appropriate class.

Taxation of Illness Benefit

Illness Benefit has been reckonable as income for income tax purposes since 6 April 1993. The Department pays Illness Benefit directly to recipients without any deduction for tax.

To assist in the taxation of claims for Illness Benefit from employment, this Department notifies the employer of the taxable amount of Illness Benefit to be taken into account for income tax purposes. The Department also notifies the Office of the Revenue Commissioners concerning payments and taxable amounts that have issued to customers.

Illness Benefit, both the personal rate and adult dependant allowance (excluding any increases for child dependants), is considered as income for tax purposes and is taxable from the first day of payment.

Increases for Qualified Adult/Qualified Child

Increases of Illness Benefit are payable in respect of a Qualified Adult and in respect of a qualified child. (See separate guideline on Dependants - Increase for a Qualified Adult or Dependant - Increase for a Qualified Child).

Increase for Qualified Adult

Currently an increase for a Qualified Adult may be payable where the spouse/partner has average weekly gross earnings/income of € 310 and under.

Increases for a qualified adult of an EEA national or of a person having the official status of refugee or stateless person living in the EEA are payable notwithstanding the fact that such adults are resident in another Member State of the European Economic Area (EEA) or are not nationals of a Member State of the EEA.

Increase for Qualified Child

Increase for a qualified child is payable up to when a child reaches 18 years of age. Where a child reaches 18 years of age and Illness Benefit remains in payment, the customer is entitled to be paid in respect of that child for a 3 month period either when the child finishes 2nd level education or when the child completes the Leaving Certificate examination.

From September 2003 the payment of an increase for a child dependant was extended up to age 22 for a child dependant who is in full-time education.

Where a qualified child is also entitled to or in receipt of a Social Welfare benefit or assistance payment in their own right, or where an increase for a qualified adult is payable in respect of that person, the increase for a qualified child cannot be paid in addition to the other benefit, assistance or allowance.

The increase is not payable in respect of a qualified child who resides with the customer and the spouse/partner of the customer where the spouse/partner has average gross weekly income of € 400.00 or more. The spouse's/partner's income is calculated in accordance with the legislation governing the determination of a qualified adult dependant.

Where the customer's spouse or partner is residing with the customer but is not a Qualified Adult, any increases for qualified child are payable at half of the standard rate where the spouse/partner has average gross weekly income of €400.00 or less. This condition is effective from 19 January 2004 and does not apply to a customer who, immediately before the 19 January 2004 was entitled to or in receipt of a payment which included an increase in respect of a child.

This saver shall continue to be effective for as long as the customer continues to be entitled to or in receipt of the increase in respect of the child.

The full rate increase for a qualified child is payable where the customer in receipt of Illness Benefit is receiving an increase for a Qualified Adult or is a lone parent who is not in receipt of One Parent Family Payment/Widow's Pension/Deserted Wife's Benefit (See separate guideline on "Dependants - Increase for a qualified child").

In order to process claims for Illness Benefit it is necessary for all customers, their husband, wife, or partner and all children to have Personal Public Service Number (PPSN). Where a PPSN is not available or cannot be traced, this Department needs the person's birth certificate to verify their date of birth.

This requirement is indicated on the Illness Benefit claim form. Where details are not fully completed on claim form, this Department issues a letter to the customer requesting a birth certificate. A Birth Certificate may be obtained at a reduced rate from the Superintendent Registrar for the area in which the birth occurred, provided the letter from this Department is enclosed with the application.

Extra Benefits

If a customer is getting Illness Benefit, they may also qualify for:

Assistance under the Supplementary Welfare Allowance Scheme, for example:

  • Back to School Clothing and Footwear Allowance,
  • Diet Supplement,
  • Exceptional Needs Payments,
  • Rent Supplement,
  • Urgent Needs Payments.

Services provided by the Health Service Executive (HSE):

  • Medical Card
  • GP Visit Card
  • Drugs Payment Scheme
  • Long-term Illness Scheme

Civil and Public Servants recruited on or after 6th April 1995

Civil and Public Servants appointed on or after 6th April 1995 pay Class A PRSI and are covered for appropriate benefits and pensions including Illness Benefit.

On appointment, officers are required to sign suitable mandates authorising the payment of any benefits due to them, under the social insurance system, directly to their employing Department. Staff, who are absent due to illness for more than 3 days, must submit form MC1 (claim form for illness benefit/injury benefit) to Department of Social Protection. Also, on MC1 under 'payment method' they must indicate that any payment due, is to issue directly to their employer.

Sharefishermen/women

What is "Share fishing"?

In the fishing industry, one of the traditional methods of payment to crewmen/women working on board fishing vessels is by a 'share' of the value of the catch. A person who works in the fishing industry and is paid solely by 'share' of the catch is a Share Fisherman/woman

That person's entitlement to Illness Benefit (IB) depends on whether they are categorised as an employee or a self-employed person. An employee generally pays PRSI contributions at Class A which counts towards IB while self-employed contributors pay PRSI contributions at Class S which does not count towards IB.

Share Fisherman/women paying PRSI at Class S

In a judgement dated 2 October 2001 the High Court ruled that two named Share Fishermen were not employed under contracts of service (that is as employees) by their boat-owners/skippers. The judge relied on a previous High Court case (in 1986) in coming to her decision.

The main factors which determined that a crew were not employees of the boat owner but partners in a joint venture were: -

  1. That each weekly voyage was a separate venture and no crewmember had a contract that entitled him to take part in any subsequent voyages.
  2. Crewmembers did not receive payment of wages for participating in a fishing expedition but became entitled to a share in the net profits (if any), and
  3. Most importantly, although the boat-owner/skipper engaged each crewmember he did not decide what the rate of remuneration would be. This was determined partly by custom (50% of the profits being allotted to the boat) and partly by agreement between the parties.

It follows from this judgement that Share Fishermen/women working in circumstances where the three factors mentioned above apply and are paid solely by share of the value of the catch are likely to be self-employed and paying PRSI contributions at Class S provided that they have reckonable income of €3,174 or more a year. Therefore they are not entitled to Illness Benefit.

Optional Class P Contributions

Self-employed Share Fishermen/women may opt to pay additional PRSI contributions at Class P which entitles them to Illness Benefit for 1 year (312 payment days).

It is important to note that the High Court judgement only applies to Share Fishermen/women who are paid solely by share of the value of the catch. A fisherman/woman who is paid by fixed basic wage or salary is more likely to be an employee of the boat-owner or skipper (and to pay PRSI contributions at Class A).

If a sharefisherman/woman applies for Illness Benefit the claim must be referred to Scope Section, Department of Social Protection. Scope Section will decide if the correct PRSI contributions have been paid. Illness Benefit section will then decide on the person's entitlement to Illness Benefit based on the decision made by Scope.

Duration of Payment

Limited duration – 312 days (L312)

A customer who has paid between 104 and 259 contributions at an appropriate class, since entering employment, is entitled to receive payment of Illness Benefit for a maximum of 312 paid days in any one period of interruption of employment. A claim category of 'limited duration 312 days' (L312) applies in this case.

Limited duration – 390 days (L390)

Prior to 1 Feb 2012 a customer who had paid a total of 260 or more contributions at an appropriate class, since entering employment, and was in receipt of a Widows, Widowers and Surviving Civil Partners Pensions and One-Parent Family Payment, was entitled to receive payment of Illness Benefit, concurrently with the other payment, for a maximum of 390 paid days in any one period of interruption of employment.

From 1 Feb 2012 the concurrent payment of Illness Benefit and Widows, Widowers and Surviving Civil Partners Pensions and One-Parent Family Payments was stopped for new claims. Existing clients in receipt of both payments on 1 Feb 2012 were allowed to continue to receive the balance of their entitlement (i.e. the balance of 390 days).

Limited duration – 624 days (L624)

From 5 January 2009 a customer who has paid a total of 260 or more contributions at an appropriate class, since entering employment, is entitled to receive payment of Illness Benefit for a maximum of 624 paid days in any one period of interruption of employment. A claim category of 'limited duration 624 days' (L624) applies in this case (that is where the customer's claim started on/after 5 January 2009).

Exception to limited duration 624 days

  • A customer who makes a claim for IB which starts after 5 January 2009 but which is part of the same period of incapacity (in other words not separated by more than 3 days) as a previous IB claim which started before 5 January 2009 will be entitled to payment for a continuous duration. To form the same period of incapacity the new IB claim can be linked to the previous IB claim through a paid claim for Illness Benefit, Occupational Injury Benefit, Invalidity Pension, Back to Work Allowance, Back To Education Allowance, Carer's Allowance or Carer's Benefit.

For example, a customer is in receipt of:

  • IB from 22 September 2008 to 20 January 2009
  • Carer's Allowance from 21 January 2009 to 30 April 2009
  • Claims IB from 1 May 2009. This customer is entitled to receive payment of IB for a "continuous duration" as each claim is not separated by more than 3 days and, therefore, form one period of incapacity.
Continuous duration (CD)

Prior to 5 January 2009 a customer who has paid a total of 260 or more contributions at an appropriate class, since entering employment, is entitled to receive payment of Illness Benefit for as long as that customer is incapable of work up to the age of 66. A claim category of 'continuous duration' (CD) applies in this case.

A customer who was in receipt of Illness Benefit on 4 July 1988 (when the total contributions required changed from 208 to 260) is entitled to Illness Benefit continuously if their claims form a part of a period of incapacity for work which commenced before 4 July 1988.

Requalification after expiry of Illness Benefit

To requalify for Illness Benefit after expiry of 312 or 624 days a customer requires:

  • 13 contributions paid after the end of their IB entitlement
  • a lesser number contributions to be paid after expiry if it brings the total contributions paid up to 260 (in the case of expiry after 312 days)

A contribution paid in respect of a day(s) worked in the week of expiry may be regarded as one of the 13 paid contributions even if that day(s) was before the last day of entitlement.

A customer may use relevant periods in other Member States of the European Economic Area (EEA) where a customer has insufficient Irish contributions- see earlier paragraph in this regard.

Jobseeker's Benefit or Allowance Payable Pending Illness Benefit Appeal

Where a customer has been disallowed Illness Benefit because they have been found "capable of work" (in other words their present state of health would not prevent them from resuming or taking up work) following an assessment by a Medical Assessor, it may be accepted that they fulfil the condition of being capable of work - notwithstanding any statement by the customer that they do not consider themselves to be capable of work.

This is so, even if the decision of the Medical Assessor is under appeal. The customer is entitled to apply for Jobseeker's Benefit or Allowance if they are not resuming employment even if they are appealing against disallowance of Illness Benefit. While the appeal is ongoing they should continue to send in medical certificates of incapacity for as long as their doctor considers them incapable of work through illness.

Certain general incapacities which are accepted/refused for IB purposes

"Debility" or "General Debility", "Gambling", and "Illness" are not accepted for IB purposes. Any medical certificates received bearing these incapacities are returned with a request for a more specific incapacity.

Pregnancy, including confinement, is not accepted for the purposes of Illness Benefit. However, "Complications of Pregnancy" is an acceptable incapacity for Illness Benefit purposes.

"Malaise", meaning 'a general feeling of being unwell', is an acceptable incapacity.

"Addiction" is accepted once the General Practitioner specifies that the addiction is drugs or alcohol related.

Medical certificates are also accepted once the customer is attending/awaiting treatment at the Rutland Centre, Cuan Mhuire or any other recognised treatment centre (list of centres held by the Higher Executive Officer in New Claims Section).

Defence Forces

Although NCO's and enlisted personnel of the Defence Forces pay PRSI at Class H which gives cover for IB, they are not entitled to claim Illness Benefit while serving. However, a customer who has been discharged from the Army can claim Illness Benefit. Their "Discharge Papers" must be submitted before the claim can be authorised. Receipt of an army pension by a customer does not affect their entitlement to Illness Benefit.

Disqualifications

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

Imprisonment

A customer is disqualified for Illness Benefit during any period where they are undergoing penal servitude, imprisonment or detention in legal custody.

Payment of any increase in respect of a Qualified Adult is disqualified during any period where the customer's spouse/partner is undergoing penal servitude, imprisonment or detention in legal custody (See separate guideline "Imprisonment").

Trade Dispute

A customer in receipt of Illness Benefit is not entitled to an increase for a Qualified Adult in respect of a spouse/partner who is or would be disqualified from the receipt of Jobseeker's Benefit or Jobseeker's Allowance because of participation in a trade dispute.

A claim for Illness Benefit may be received from a customer who is disqualified from receiving Jobseeker's Benefit due to their direct interest or involvement in a trade dispute. Details of any such Illness Benefit claim may be recorded in New Claims Section and sent to MR Control Section for an urgent medical assessment.

Penalty for false or misleading information

Penalties for false or misleading statements made to receive Illness Benefit include fines or imprisonment or both. (See separate guideline "Prosecutions")

Payment after death:

SW Consolidation Act 2005, Section 248 refers.

If a customer dies while receiving Illness Benefit, payment will continue for 6 weeks after their death, to their spouse or partner if the payment

  • included an increase for them as a qualified Adult (or would have except that they were getting another Social Welfare payment in their own right).

If a Qualified Adult or a qualified child dies, the increase due for that person will continue to be paid for 6 weeks after their death, or less if the customer returns to work before the end of the 6 week period.


PART 2
CLAIMS, INVESTIGATION AND DECISION PROCEDURES

Claims

Claims for Illness Benefit are normally made on form MC 1, stocks of which are held by doctors, and should be made within 7 days of the customer becoming ill. This form as well as being an application form contains a section for the doctor's certificate.

The claim form should be submitted to:

Department of Social Protection,
PO Box 1650,
Dublin 1.

Application forms may also be posted or handed in to the local Intreo Centre or Social Welfare Office.

If a medical certificate is received without the MC 1 application form, a claim form IB/OB 1 is issued for completion by the customer. However, pending return of this form, a claim is opened based on the details on the medical certificate and is processed in the normal way.

If the medical certificate is not signed by the customer, it is returned to them for completion. A claim is opened but not authorised until certificate has been returned properly signed.

Certain workers* (who are nationals of a Member State of the European Economic Area and persons who have the official status of refugee or stateless person) and who are in another Member State of the European Economic Area apply for Irish Illness Benefit through the relevant social security institution of the Member State in which they reside/stay. They do this by submitting a notification of cessation of work or a medical certificate (depending on the system operating in the country in which they live) to the relevant institution in the place where they live, within 3 days of the commencement of incapacity.

However, where a claim is submitted to the relevant institution within 21 days of commencement of incapacity, the date of claim is the date on which it was received in the relevant institution.

* See section "Payment while on holidays or abroad".

In the case of workers who are covered by EU legislation there is provision in that legislation for payment of benefit on a provisional basis where there is a dispute between the social security authorities or institutions of two or more Member States of the EEA over whose legislation should apply or who should pay benefit. In such cases the person concerned who could claim benefits if there was no dispute shall provisionally receive benefits provided for by the legislation of the Member State in which they are habitually resident. Where they are habitually resident in neither of the Member States involved, they can receive benefits in the Member State to which their claim was submitted in the first instance.

Certification

Medical evidence of incapacity is normally furnished on the official form MC 1. However, certificates on the doctor's own notepaper are accepted in certain circumstances (e.g. customer attended at Accident and Emergency in a hospital rather than their GP in the first instance). For customers who wish to have a claim backdated for a significant period of time, they should request a detailed letter from their doctor rather than requesting back-dated certificates in bulk.

Medical Certificates are only accepted from doctors who have been appointed as Medical Certifiers by the Department. Where a certificate is received from a customer who has not been appointed a Medical Certifier, it is referred to the Department's Chief Medical Adviser for a recommendation as whether the evidence of incapacity is acceptable.

Medical certificates received from bone setters are referred to the Department's Medical Adviser for advice on whether the medical evidence is acceptable.

Intermediate Certificates

Illness Benefit is paid in arrears. This means that, other than in cases where the first medical certificate indicates a date on which the customer is fit to resume employment, a further medical certificate is required before the claim can be put into payment.

Further medical certificates, referred to as 'intermediate certificates' (form MC2) are required for each week of incapacity. When a customer is fit to resume employment (or be available to seek work), a final medical certificate is normally submitted indicating the date on which the customer will be fit for work.

Customers covered by EU legislation who are:-

  • habitually resident in another Member State of the EEA e.g. frontier worker working in Ireland but living in Northern Ireland
  1. or
  • staying in another Member State of the EEA for the purpose of receiving medical treatment authorised by the Department of Health and Children or the Health Service Executive
  1. or
  • undergoing emergency treatment during a stay (e.g. holidays) in another Member State of the EEA
  1. or
  • posted workers subject to Irish legislation while working in another Member State of the EEA

should submit a certificate of incapacity for work issued by a doctor providing treatment.

If doctors in that country do not provide certificates, the customer should notify the social security institution of that country so that a medical assessment can be arranged. The medical report should specify the probable duration of incapacity. Any other medical assessments will be arranged as if the customer were insured in that country.

Late Claims

SW Cons. Act 2005 Section 241 refers:

Illness Benefit should be claimed within 7 days of becoming incapable of work. However, a claim may be accepted up to 21 days from the date of commencement of illness. Where there is good cause for the delay in making a claim, the maximum period for which payment can be made is 6 months from the date of receipt of the claim in the Department.

See separate guidelines entitled "Claims and Late Claims".

Decisions

All claims to Illness Benefit are examined by a Deciding Officer in Benefits Section. The contribution and earnings conditions to determine entitlement are investigated by reference to the PRSI records of the Main Central Records Section.

When a claim is decided and a rate greater than zero applies, the customer is notified of their payment rate, along with general information on Illness Benefit on form IB 8 (provided the claim does NOT open and close on the same medical certificate (MC 1)).

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

A customer who is not satisfied with the decision of the Deciding Officer on their 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 separate GUIDELINE on Appeals)

Any claim, declaration or appeal relating to Irish Illness Benefit made to the appropriate institution of a Member State of EEA is accepted by the Department. The date of receipt of a claim, declaration or appeal in the appropriate institution is the date of submission of a claim, declaration or appeal to this Department.

Illness Benefit/Disability Allowance customers

An applicant for Disability Allowance to whom Illness Benefit is payable (but at a reduced rate of payment) may opt to forgo the Illness Benefit payment in order to receive Disability Allowance at a higher rate (when adjustment has been made to take account of means, if any).

Where this option is implemented (i.e. the IB payment ceases), it is no longer necessary to keep the claim open for credit purposes. Disability Allowance Section in Longford allows credits retrospectively when the Disability Allowance claim closes e.g. when the client goes to the State Pension.

When a customer on Illness Benefit becomes entitled to payment of Disability Allowance, the Disability Allowance Section advises them that it is no longer necessary to send in medical certificates.

No new Illness Benefit claim is opened in any case where the customer is receiving a Disability Allowance payment. Instead the medical certificate is returned to the customer along with an explanatory form.

Illness Benefit and Disablement Benefit

Illness Benefit is payable with Disablement Benefit except where Disablement Benefit includes an increase for Incapacity Supplement.

(Section 247(3a) and (3b) of the Social Welfare Consolidation Act 2005, as amended)

Pre-Entry Credits (PECs)

Persons, who paid PRSI (Class A, E, H or P) for the first time between the start of the relevant GCY and the date of the claim, are entitled to credited contributions in order to satisfy the 2nd contribution condition for Illness Benefit.

When it is confirmed that 104 contributions (1st condition) have been paid, PECs are awarded from the beginning of the contribution year in which the date of entry (DOE into Irish insurable employment) occurs, up to the date of entry, and also the previous two contribution years.

If a customer's first PRSI contribution is not reckonable for IB, i.e. at a class other than A, E, H or P, Pre-Entry credits awarded will not satisfy the 2nd contribution condition.

Student Credits

Student credits are awarded where the customer was a full-time student during the relevant tax year and had contributions paid prior to attending college/during the period spent at college. The conditions for the award of student credits are as follows:

  • the customer must have 104 contributions paid since date of entry into insurable employment
  • the course must have been full-time and commenced before the claimant was 23 years of age
  • the customer must have re-entered insurable employment after the course of education ceased and
  • a letter from College must be submitted to confirm duration of the course.

Student credits are awarded from the beginning of the contribution year up to the date the customer re-enters insurable employment, and for the previous two complete tax years. Student credits may be awarded once only.


PART 3
PROCEDURES FOLLOWING AWARD

SW Cons. Act 2005. Section 242 & S.I. 142/2007 refers

Payment

Illness Benefit is paid weekly in arrears on receipt of required medical evidence. There is no fixed date of payment and the first day for payment purposes is the first day of incapacity, excluding Sundays which is not counted for payment purposes.

Generally, Illness Benefit is paid up to the date on the last certificate received for people who are sending in certificates weekly. Autos (i.e. persons on monthly certificates) are paid weekly in advance e.g. a payment issues on a Monday paying to the following Saturday.

Payment method

The preferred payment option is by Electronic Funds Transfer (EFT) directly into a Bank or Building Society account. However, where bank account details are not supplied customers continue to be paid by cheque. Certain long-term Illness Benefit customers were formerly paid by book through the post office network but this practice has ceased. Some of these customers have opted to continue to be paid by post draft which helps a person maintain their link with the post office.

Maintenance

Stop/Review dates are inserted in 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.

If a cheque payment is lost or not received by the customer, they are required to complete a Form of Indemnity to the effect that they have not received/lost their payment. A replacement cheque may issue on foot of this statement. At this point the customer is also invited to change their payment method from cheque to EFT.

The Form of Indemnity provides that should an overpayment of IB occur as a result of two payment instruments being cashed by them in respect of the same period, the overpayment must be refunded to the Department.

Frequency of certification

Customers are normally required to submit medical certificates of incapacity on a weekly basis. Where a customer has been incapable of work for 6 months they will normally be required to certify once every four weeks. For certain serious illnesses a customer will be advised to submit a medical certificate at four-weekly intervals shortly after commencement of the claim.

Customers are advised of any changes in frequency in submitting of medical certificates.

Stop Dates

Stop dates for customers reaching pensionable age (currently 66), and qualified children reaching 18 years of age are put in automatically when a claim is being authorised. Other stop dates for review purposes (for example, awaiting confirmation of EU contributions, customer on Illness Benefit with Maternity Benefit also being claimed) are inserted by the Deciding Officer, usually when the claim is being authorised.

Medical Referral Assessments

During the course of a claim to Illness Benefit, a customer will be asked to attend for medical assessment by a Medical Assessor for a second opinion as to whether they are incapable of work. (See separate guideline on "MED_ASSESSMENT").

The opinion of the Medical Assessor following this assessment is submitted to a Deciding Officer for consideration regarding the customer's continued entitlement to Illness Benefit.

In any case where payment of Illness Benefit is disallowed, the customer is notified of the decision and advised of their right to appeal against the decision.

For persons in another Member state of the EEA referred to in the paragraph headed "Intermediate Certificates", medical assessments on behalf of the Department are carried out in the country in which they are staying/residing at the request of this Department.

Payment while on holidays or abroad

In general, a customer travelling to another EEA Member State is entitled to be treated as if they never left the State, regardless of the reason for leaving the State.

However, as the continued issue of payment(s) is dependent on the receipt of medical certificates the customer should notify the Department (where possible) in advance to ensure that payment continues e.g. switched from medical certification to monthly certification.

A customer, who wishes to go to a non-EEA country for health reasons, may be entitled to Illness Benefit for the duration of their absence. While each such case is treated on its own merits, a decision on entitlements to Illness Benefit must take into account such factors as duration of claim at the time the application is received, nature of incapacity and the likely period that is 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. (See Guideline "Absence from the State")

Incapacity Gap

Where the decision of the Deciding Officer in any case that a customer is capable of work is upheld on appeal by an Appeals Officer, but the Appeals Officer applies their decision on the appeal from a date later than that of the Deciding Officer, (i.e. there is a gap between the date of disallowance by the Deciding Officer and the effective date of the Appeals Officer's decision), the Deciding Officer may, following consultation with the Chief Medical Adviser, allow payment for the period of the gap if they are satisfied that the person was incapable of work during that period.

IB Appeal Credits

A person is entitled to a credited contribution for each week of incapacity (See separate guideline on "Credit Awards"). Where a customer has been disallowed IB 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 the customer.

In cases where, following a capable decision by the Appeals Officer, the customer continues to submit medical evidence of incapacity, a letter issues telling them to stop sending in certificates.

Social Welfare regulations provides for the award, at the Minister's discretion, of credited contributions to a client who has been found capable of work by an Appeals Officer.

Special credits are awarded from the date of disallowance of IB/OIB up to the end of the contribution week following the week in which the Appeals Officer's decision issues to the customer. The credits are allowed solely to ensure that a customer would not have a gap in their insurance record pending the outcome of the appeal and the period for which such credits are allowed is not a period of incapacity for work within the meaning of the Social Welfare Acts.

Such periods cannot, therefore, be used for linking purposes.

Where a customer, who has been found 'capable on appeal', has been receiving Jobseeker's Benefit or Allowance or has been signing for JB/JA credits during the entire appeal period, no special credits will be allowed as the unemployment credits are valid in such situations.

Where a client, who has been found 'capable on appeal', has not been receiving Jobseeker's Benefit or Allowance or has not been signing for JB/JA credits during the entire appeal period, special credits will be allowed only in respect of the period(s) for which no JB/JA credits have been awarded.

EXAMPLE: If the customer did not sign on for 2 weeks after the disallowance of IB, special credits would be allowed for those weeks only; if a customer exhausted JB entitlement before the end of the appeal period and did not claim JA or sign for JA credits subsequently, special credits would be allowed from the day following JB Ben EX.

In any case where a customer has been signing on pending the outcome of an appeal, the SWLO should be notified if the customer loses the appeal. The reason for this is that during the appeal period, the Local Office does not review such claims regarding the customer's satisfying the condition of "genuinely seeking work".

In the event that the appeal fails, the Local Office will pursue this aspect with the customer.

Health and Safety Benefit - Implications for payment of IB

Illness Benefit is not payable in the 21-day period prior to payment of Health and Safety Benefit (HSB), where payment is being made by an employer in respect of Health and Safety Leave.  However, where a claim to HSB is under consideration payment of Illness Benefit may be allowed, pending the decision on the HSB claim.

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 customer claims for a qualified adult increase in respect of a spouse or partner who is not living with them, a questionnaire (form IB 46) may issue to the spouse/partner to obtain details in relation to income from employment/Social Welfare payment, maintenance being paid by customer, whether support is voluntary or under Court Order, etc.

Assessment of Damages in Civil Cases

In cases where a customer brings a civil action, account shall not be taken of Illness Benefit when assessing damages at common law. However, Illness Benefit is assessable:

(a) in any court action for personal injury relating to the use of a mechanically propelled vehicle insurable under the Road Traffic Acts or

(b) in any other action relating to the use of a mechanically propelled vehicle, for the period of 5 years beginning with the time when the cause of the action accrued.


Part 4
General Provisions that apply to Scheme

Previously found capable

Where a customer was previously found capable of work by a Medical Assessor and subsequently submits a fresh claim in respect of the same incapacity, payment is not normally authorised until the customer has attended for medical assessment, or until the customer's appeal has been allowed.

Where a customer previously found capable of work by a Medical Assessor submits a fresh application for a different incapacity, payment may be allowed and the customer referred for an early medical assessment.

Medical assessments carried out in another EEA country on behalf of this Department are taken into account in determining whether a customer is capable or incapable of work.

Payment to appointed persons

SW Cons. Act 2005 Section 244(a) & S.I. 142 of 2007 Articles 201 – 208 refer

Where a customer requests that payment issues to somebody other than themselves the name being used for payment purposes may be changed. For all cases, other than where a customer is in hospital, a submission is made to a 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

SW Cons. Act 2005 Section 335 & S.I. 142 of 2007 Articles 242 – 249 refer.

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 an overpayment. A copy of the Department's Information Leaflet on the Code (leaflet SW 2) is issued to the customer when they are being notified of an overpayment relating to the Illness Benefit scheme.

(a) Procedures for recovery of overpayment

The Department applies the principle of natural justice in all cases and writes to the customer telling them how the overpayment happened and invites them to submit comments before a formal decision on the recovery of the overpayment is made. In all cases 21 days are allowed for a reply.

Overpayment as a result of a Revised Decision:

  • When an overpayment has been assessed as a result of a revised decision on a claim (e.g. customer being paid at a rate or in receipt of an allowance to which they are not entitled) Form OR 1 and Form OR4 & Mandate issue with Information leaflet SW2, informing the customer of the amount of the overpayment and the intended level and method of recovery.

They are given a right of review and/or appeal of the decision. If, on review, the decision stands the customer is informed and they are given a further 21 days to appeal.

Overpayment as a result of Non-revised Decision:

  • When the overpayment has been assessed due to a "non-revised" decision (e.g. where the overpayment has occurred as a result of the failure of the customer to submit a final certificate on time), Forms OR 2 and OR4 & Mandate issue with Information leaflet SW 2, informing the customer of the amount of the overpayment and the intended level and method of recovery.

They are given a right of review of the decision, to be submitted within 21 days. There is no right of appeal in the case of non-revised decisions.

Overpayment as a result of concurrent working and claiming:

  • When an overpayment has been assessed due to concurrent working and claiming by a customer, a Decision Letter, and Forms IB OR 8 & IB OR4 (and a Mandate if the customer is not in receipt of any Social Welfare payment) issue with Information leaflet SW2, informing the customer of the amount of the overpayment and the intended level and method of recovery, and also that consideration is being given to taking legal proceedings against them.

They are given a right of review and/or appeal of the decision. If, on review, the decision stands the customer is informed and they are given a further 21 days to appeal.

(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/partner has other income (e.g. from employment or other SW payment) that brings the family income substantially above the SWA level for their family circumstances then the SWA level does not have to be applied.

Similarly with regard to customers who qualify for reduced IB the overpayment is not recovered unless there is other substantial income in the household. The recovery position will be reviewed if a customer's circumstances change in the future.

(c) The following methods of recovery may be used:
  1. (i) withholding Social Welfare arrears which may be due to the customer or their spouse/partner, excepting arrears of Child Benefit.
  2. (ii) making deductions from ongoing or future Social Welfare payments to the customer or their spouse/partner, excepting Child Benefit payments.
  3. (iii) a single payment to repay the overpayment in full,
  4. (iv) weekly repayments by means of cash, cheque, postal order or standing order,
  5. (v) seek recovery of overpayment from an employer (where appropriate1).
    1 examples would be where overpayment arose through concurrent working and claiming by an employee, and the employer's failure to maintain records, make PRSI returns or failure to notify the Office of the Revenue Commissioners of the commencement of employment allowed the concurrent working and claiming to occur.
  6. (vi) seek recovery by requesting the social security institution of another Member State of the EEA to deduct the amount of Irish Illness 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 Illness Benefit). See Article 72 of Regulation (EC) No. 987/09.
  7. (vii) where a customer was paid social assistance by the social security institution of another EEA Member State during a period when they were entitled to Illness Benefit under our legislation, the institution which gave the assistance may request the Department to deduct the amount of assistance from the amount of Illness Benefit which the Department pays. The institution requesting recovery must be legally entitled to reclaim the benefits from the customer concerned.
(d) Appeal

Where the customer lodges an appeal to the independent Social Welfare 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 have elapsed and the recovery procedure is already in place then the recovery continues pending the outcome of the appeal. In the case of concurrent working and claiming, if a late appeal is accepted after 21 days have elapsed, and legal proceedings have already been initiated, this process may continue pending the outcome of the appeal.

The date of receipt of an appeal relating to Illness Benefit by an authority, institution or tribunal in another Member State of the EEA which should have been submitted to the Social Welfare 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 - see form E212.

Conditions while receiving Illness Benefit

While receiving Illness Benefit, the customer must not:

  • become incapable of work through their own misconduct,
  • fail, without good reason, to attend a medical assessment by a Medical Assessor of the Department,
  • fail to obey their doctor's instructions,
  • behave in a way that is likely to delay their recovery,
  • fail to see any Officials from this Department and answer reasonable enquiries concerning their claim.

A customer must get written permission from the Department before starting:

  • an approved training course with a view to taking up some other occupation.

A customer may do the following types of work without getting written permission from the Department before starting:

  1. light work for which no remuneration is, or would normally be payable,
  2. work undertaken primarily as a part of his or her treatment while he or she is a patient in, or of, a hospital, sanatorium, or other similar institution and his or her weekly earnings in respect of that work do not exceed €50,
  3. work under a scheme which is, in the opinion of the Minister, charitable in character and purpose and his or her weekly earnings in respect of that work do not exceed €50.

Applications to commence Voluntary Work whilst in receipt of Illness Benefit are dealt with in Partial Capacity Benefit section, who should be contacted directly.

FÁS/SOLAS Training Course

Customers in receipt of Illness Benefit do not apply for Partial Capacity Benefit (PCB) when seeking to participate on a FÁS/SOLAS training course. However, they must apply for and receive permission from the Department of Social Protection to engage in the course before commencement. Customers should contact PCB section directly to make their application.

Contact information as follows:-
Patrial Capacity Benefit Enquiry Form

01-7043950/3039/3735/3991

All applications should be made a minimum of six weeks before that start date of the course.

Applications may be made by the individual of by FÁS/SOLAS, and all applicants must make an application on the official Form (141C) available from PCB section.

This is a two page form that asks the customer for

  1. Personal details and a declaration to be signed by the customer
  2. Information from the training/education provider
  3. A short section to be completed by their GP.

Since January 2014 new participants on FÁS/SOLAS training courses can retain their Illness Benefit payment but cannot receive a training allowance at the same time.

Opinion of Medical Assessor

In certain situations where there may be health and safety concerns regarding the training/education described the application may be forwarded to the Medical Assessor for consideration.

Further Education Courses

Customers in receipt of Illness Benefit who advise that they are participating in education courses, which do not have a work content, are not treated as an application to commence employment and do not need to make an application for Partial Capacity Benefit as these courses are not regarded as constituting training or part-time work.

Customers now make an application using the same application form as customers wishing to undertake a FÁS/SOLAS course (141C).

FÁS/SOLAS Specialist Training Provision:

There is no requirement to complete Forms IB141 and IB141A where the FÁS/SOLAS application is for specialist training for persons with disabilities. Such applications are normally processed without reference to a medical assessor. PCB section should be contacted directly by the individual's social worker or the course provider.

Vocational Training Opportunities Scheme (VTOS)

While Illness Benefit is not designated as a qualifying payment for VTOS nonetheless Illness Benefit customers are allowed to participate on VTOS courses provided their GP confirms in writing that participation on the course is not likely to have an adverse effect on the customer's health and is not likely to retard their recovery. Again applications should be made using the 141C.

NOTE: IB customers participating in further education courses (including VTOS) are subject to the normal medical referral control courses.

Back to Work Allowance (BTWA) – closed to new applicants from 1/5/09

Back to Work Enterprise Allowance (BTWEA) Refers to claims made on or after 5/1/2009

Back to Work Enterprise Allowance is payable for 2 years while self employed. Customers will receive 100% in year one and 75% in year two. Customers must be in receipt of a qualifying payment for 3 years immediately prior to commencing employment and accessing BTWEA. The period on Illness Benefit can count towards the qualifying period for the purpose of accessing BTWEA.

Back to Education Allowance

Customers in receipt of Illness Benefit for at least 2 years and who want to return to education, may transfer to the Back to Education Allowance (BTEA) scheme. See information booklet SW 70 for more information.

Last modified:24/07/2015
 

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