Incapacity Benefit

• A guide to Incapacity Benefit
• Can I get it?
• Medical Assessments
• Disputing and Appealing against a decision
• How to appeal
• More Information

A Guide to Incapacity Benefit

Incapacity Benefit gives financial help to people who are not working because they are sick or disabled.  It can be paid based on the number of National Insurance contributions they have paid or have been credited, or if they were sick or disabled when they were 16 or over but under 20, (25 if they were in education or training before 20) may be able to claim under the youth provisions.

People who have reached state pension age cannot normally get Incapacity Benefit.  State pension age is currently 60 for women and 65 for a man.  This will be equalised at 65 for both men and women from the 6th of April 2020.  The change from the current pensionable age of 60 for women to 65 will be phased in over a 10-year period from 2010 to 2020.  For more information, a leaflet is produced from your local Social Security Office, called, You and State Pensions, leaflet number PM2.

If you can not get Incapacity Benefit, you may still be able to get National Insurance Credits for each full week that you are sick. A full week starts on Sunday and ends on Saturday.  If you do not have enough money to live on, you may be able to get income support. For more information collect leaflet SD1, 'Sick or Disabled'.

Can I get it?

Incapacity Benefit is available to people under state pension age who are not working because they are sick or disabled.  Employed people who are not getting Statutory Sick pay, self-employed and unemployed people, widows and widowers whose spouse died before 6 April 2001 and those who wish to claim under the youth provisions can claim Incapacity Benefit.

You should complete and return the appropriate claim form as soon as possible after you think you may get Incapacity Benefit. If you do not you may lose benefit.

Do not delay making you claim for benefit. For more information about time limits, contact you Jobcentre Plus (this is an external hyperlink) or Social Security Office

If you are employed

If you are employed and you become sick, your employer may be liable to pay you Statutory Sick pay. As soon as you become sick, you should check with your employer to see if they will pay you statutory sick pay.

If your employer cannot pay you, or has to stop paying you Statutory sick pay, they will give you an SSP1 Claim pack.  This will tell you why you cannot get Statutory sick pay.  The form also contains sections for you to complete to claim Incapacity Benefit.

If you employer does pay you statutory sick pay, they will only be able to do so for a maximum of 28 weeks.  If you are still sick after 28 weeks, you should claim incapacity benefit.  Your employer should issue you with an SSP1 claim pack before the 28 week statutory sick pay period runs out. This is to make sure that we can find out if you are entitled to Incapacity Benefit before your Statutory Sick pay ends.  Your employer should fill in the first section of the claim form before giving it to you to complete.

If you are self employed or unemployed

If you are self-employed or unemployed and become sick, you should claim incapacity Benefit on an SC1 claim form. If you are both employed and self employed, the rules for employed people apply, and you should ask your employer about Statutory Sick Pay.

Further information is available within the 'A guide to Incapacity Benefit' booklet which is available from your local Social Security Office.

Medical Assessments

In order to find out if you are still incapable of work, you may be medically assessed.  You will be assessed by one of two medical assessments: The Own Occupational Test or the Personal Capability Assessment.

If an examination is required, it will be carried out by an approved doctor.  Approved doctors are appointed by the Secretary of State and work to a consistently high standard throughout the country.  They are employed to ensure that people who have applied for Incapacity Benefit get through a comprehensive assessment of how their illness or disability effects their ability to work.

The decision on whether someone has met the threshold of incapacity is made by a decision maker in Jobcentre plus.  The decision maker is not a doctor, but makes a decision about your ability to work based on all the evidence. This will include the form IB50, the information provided by your doctor and the evidence of the approved doctor.  Incapacity Benefit will usually continue to be paid until the assessment has been completed and as long as medical evidence continues.

Own Occupation Test

Usually, for the first 28 weeks of incapacity, you will be judged in your ability to carry out your own job.  This is called the own occupation test. You may also be examined by an approved doctor.

We will only use the Own Occupation Test if you have worked for at least 16 hours a week for more than 8 weeks out of the last 21 weeks before you became incapable of work.

If the decision maker denotes that you are capable of doing your own job, we will write to you, giving an explanation, and your benefit will stop. If you disagree with this decision you can ask for a fuller explanation, or you can appeal.

Personal Capability Assessment

After you have been incapable of work for 28 weeks, or from the start of your claim if you had no regular job when you became ill, you will be assessed on how well you can carry out a range of work-related activates.

You will be asked to complete a IB50 form about your illness or disability and asked to obtain a MED 4 certificate form you own doctor.  The MED 4 will be used by your doctor to provide  further information about your medical condition.  You may also be examined by an approved doctor.  This information will give a clear picture of how your illness or disability affects your ability to perform a series of work-related activities.  This is called the Personal Capability Assessment.  The decision maker determines whether you have met the threshold of incapacity using this information.

Disputing and Appealing against a decision

Disputing a decision

You have the right to dispute any decision made by a decision maker.  You do not have to dispute a decision before appealing.  If you are not satisfied with a decision, you can ask for an explanation of why the decision was made.  If you are still not satisfied with the outcome, the decision maker will look again at the decision.  The decision maker will also consider any further evidence you submit in support of your request.

Appeals

You have the right to appeal to an independent appeal tribunal against most decisions made by a decision maker.

You can appeal to an independent appeals tribunal if you disagree with the decision made about your ability to work.

Once your case has been looked at again, if you are not satisfied with the outcome, you can appeal to an independent appeal tribunal if you disagree with the decision.

An appeal tribunal is a panel of two people who are not from the Department of Work and Pensions (this is an external hyperlink).  They will look again at the decision made about your claim.  The panel comprises of a legally qualified person and a medically qualified person.  Both people will be involved in deciding whether you are capable of work.

If your appeal is allowed and the decision is not challenged by the Secretary of State, you will get incapacity benefit again, together with the money you would have received during the time you were waiting for your appeal to be heard.

How to appeal

If you want to appeal, you should fill in the form GL24, 'If you think our decision is wrong'. Once you have filled in the information please send it back to your jobcentre plus or social security office within one month of the date of the letter telling you if your are entitled to benefit or not.

More Information

Rates of benefits

Rates of benefits are published each year in Social Security Uprating Regulations which are approved by parliament - usually in October or November each year.  Benefits are usually uprated in April, at the beginning of each financial year.

Guides and Leaflets and where to get them

All guides and leaflets mentioned are free of charge.  Social Security guides, leaflets, and some others are available from your local Jobcentre Plus (this is an external hyperlink) or social security office.

Further information on Social Services is available.

You can get further information from the Department of Work and Pensions website. Their address is www.dwp.gov.uk (this is an external hyperlink).