A Guide to Claiming Benefits if you are Unable to Work

• What benefits can I claim?
• How do I claim benefits?
• How is incapacity for work assessed?
• The Personal Capability Assessment
• What if I do not pass the personal capability assessment?

This guide looks at what benefits may be payable when you are unable to work due to illness or disability. It also looks at how incapacity for work is assessed and gives advice on how to try to avoid problems that may occur with claims.

What benefits can I claim?

Statutory Sick Pay

Statutory Sick Pay is paid by employers to employees. It may be paid at times when you are away from work due to sickness for at least four days in a row. It can be paid for a maximum of 28 weeks during any period of sickness. Statutory Sick Pay is not available to anyone who is self employed or unemployed. Certain employees may also be excluded if their earnings are below a certain limit.

See the section 'low income benefits' below if you cannot get or cannot manage on Statutory Sick Pay alone.

Incapacity Benefit

Incapacity Benefit is paid by the Department for Work and Pensions to people unable to work due to sickness. It cannot be paid with Statutory Sick Pay but may be paid when entitlement to this runs out. It is available to people under pension age (60 for women, 65 for men) who are employed, self-employed or unemployed. Incapacity Benefit is a National Insurance benefit so you must normally have paid enough National Insurance contributions before you can qualify for it. Only National Insurance contributions that have been made in the last three tax years are considered when you claim.

There are separate rules for people aged under 20 (or, in some cases, those up to 25 years old who have been in education or training) though which do not involve having had to pay National Insurance contributions.

If you qualify for Incapacity Benefit it is paid, in increasing amounts, at three different rates:

• The 'short term lower rate' of the allowance is paid for the first 28 weeks.
• The 'short term higher rate' of the allowance is paid after 28 weeks to those already receiving Incapacity Benefit or to those who have been paid 28 weeks of Statutory Sick Pay.
• The 'long term rate' of the allowance is generally payable after 52 weeks (although it can be paid sooner in certain circumstances)

Additional amounts of the Incapacity Benefit may also be payable for adult and child dependant'. For the long term rate only, an extra amount can be paid where your period of incapacity for work begins before you reach the age of 45.

Incapacity Benefit cannot be paid at the same time as certain other benefits, such as Carers Allowance, and, for claims made after 6th April 2001, a reduction in the amount payable can be made where you have an occupational or personal pension.

See the section 'low income benefits' below if you cannot get or cannot manage on Incapacity Benefit alone.

Low income benefits

If you cannot manage on Statutory Sick Pay or Incapacity Benefit or are not entitled to these then you may be entitled to Income Support due to your incapacity for work. Normally Income Support may be payable for any week in which you have worked less than 16 hours (and your partner has worked less than 24 hours). Generally, if you are uncertain about whether you qualify for Incapacity Benefit or Statutory Sick Pay then you may wish to consider claiming for Income Support at the same time. Even if you are likely to qualify for Incapacity Benefit you may wish to claim Income Support initially as Incapacity Benefit is not normally payable for the first 3 days and Income Support can help to cover this shortfall.

If you have children and have a partner who works at least 16 hours per week and you are likely to be away from work for some due to your illness or disability then your partner may be able to claim Working Tax Credit/Child Credits to supplement your families income.

Where you have to pay Council Tax or rent you may also wish to consider claiming a Council Tax Rebate and / or Housing Benefit to help with these things.

Disability Living Allowance

If you have a long term illness or disability you may also be entitled to Disability Living Allowance. See 'A guide to claiming Disability Living Allowance' for details. Please note that you do not have to be treated as incapable of work or on be on a low income in order to be able to claim Disability Living Allowance.

Credits and 'Credits only' claims

Every week for which you are treated as incapable of work for benefit purpose you get credited with a National Insurance contribution that can help towards your retirement pension. Even if you receive no benefit you should still claim and provide medical evidence when asked to protect your contribution records; this is known as a 'credits only' claim.

How do I claim benefits?

• Statutory Sick Pay can be paid where you have notified your employer that you are off sick. Your employer may have a form that they use but, if not, then you can give details of your sickness on a form SC2. Your employer cannot insist upon a sick note from your GP for the first 7 days.
• Incapacity Benefit is claimed by phoning the Department of Work and Pensions on 0800 055 6688 (calls from mobile phones may be charged). Periods of sickness beyond 7 days will need to be supported by medical certificates (sick notes) from your GP.
• Income Support is claimed by phoning the Department of Work and Pensions on 0800 055 6688 (calls from mobile phones may be charged).

Claim forms for the above benefits can be requested by telephone from the Department for Work and Pensions - you do not have to call in at the office. Claim straightaway if you are unable to work as you may lose benefit if you delay.

• Working Tax Credit/Child Credits claims are made to the Inland Revenue. Claim forms and information are available via the Tax Credit Helpline on 0845 609 5000.
• Council Tax Rebate and Housing Benefit claims are made via the Local Authority. Claim forms and information is available at the Council' Customer Services Offices.

If you claiming Jobseeker' Allowance and are unwell for a short period (less than two weeks) you may be able to continue claiming your allowance without having to break your claim and claim for Incapacity Benefit instead – let your local Jobcentre staff know if this happens.

How is incapacity for work assessed?

There are 2 main ways used for testing whether you are unfit for work and can claim benefit - 'the own occupation test' and 'the personal capability assessment'.

• For at least the first 28 weeks incapacity is based on whether you can perform your own occupation, i.e. your most recent job. This test, 'the own occupation test' is usually straightforward and is normally based on sick notes provided by your own GP which state why you are not fit for work at present.
• After 28 weeks incapacity another test, the 'personal capability assessment', can be used (see details below). In certain circumstances however there are exemptions from the assessment (again, see details below).

If you have not worked for 8 weeks out of the 21 weeks before you became ill, the 'personal capability assessment' test will apply at the start of your claim.

The personal capability assessment

The 'personal capability assessment' is a test that is used to assess whether you can perform various activities. Points can be awarded for each of the activities described in the assessment and passing the test depends upon scoring an adequate number of points. The assessment of whether you may be treated as incapable of work is purely based on the points you score. There is no consideration of whether you can actually work in any particular job.

Once the Department for Work and Pensions decide to assess you under the personal capability assessment you will be asked to complete a form IB50, otherwise known as an 'incapacity for work questionnaire'. The IB50 questionnaire asks questions which relate to capacity to perform tasks in many different areas (walking, standing, seeing, and hearing, for example) that may be restricted by physical or sensory impairments and also asks whether you are affected by any mental health problems. It is these questions which form the basis of the assessment from which points may be scored. See 'A guide to the Personal Capability Assessment' for details of the points system and for tips on completing the IB50 questionnaire.

The Department for Work and Pensions may also ask for a special medical certificate from your GP, a form MED 4, to be returned with the IB50 form. The MED 4 form asks your doctor to confirm your medical conditions. If you have more than one medical condition it is important that your GP confirms the diagnosis of all your relevant conditions on the form, not just your main one. In the meantime, until you pass (or are exempt from) the personal capability assessment, you should continue to hand in sick notes from your GP.

Although the Department for Work and Pensions may write to your own doctor for information about your health problems they may also request that you attend at a medical examination. Points indicated on both the IB50 you fill in and the form IB85 that the doctor at the medical examination completes are taken into consideration. The decision made on your assessment though, whether you score enough points to pass the test, is made by a Decision Maker at the Department for Work and Pensions. If you are requested to attend at a medical examination you may find the 'Survival Guide To Medical Examinations' helpful. In some areas of the country doctors are also asked to complete a form CR1, a capability report, at examinations. The capability report is not used in the assessment of whether you are incapable of work though.

Some people will be automatically exempt from the personal capability assessment. This includes those receiving Disability Living Allowance at the higher rate for care needs and those who are registered blind. In addition, exemptions can also be granted where people may be suffering from certain severe illnesses or disabilities. The Department for Work and Pensions will normally try to identify those who may be exempt from information they have but may chose to obtain further medical evidence to support this. Some people can also be regarded as incapable of work without being assessed under the personal capability assessment, for example, hospital in–patients. If you have, or can obtain, information suggesting that you should be regarded as exempt from the test then you could ask the Department for Work and Pensions to consider this.

What if I do not pass the personal capability assessment?

If you do not score an adequate number of points in the test you are not treated as incapable of work. This will mean that any payments of Incapacity Benefit will stop, as will any other benefits, such as Income Support, paid on the basis of incapacity for work. Any credits of National Insurance contributions being made due incapacity for work will also cease. Other benefits, such as Housing Benefit and Council Tax Rebate, may also be affected if your assessment for these benefits contained what is known as a disability premium.

Unfortunately if this happens it will usually not help to just get another sick note from your GP. This is true even if you clearly cannot work and your GP supports you in this. There are exceptions to this though. If you have a new or additional condition or have deteriorated since you were assessed then you may wish to consider putting in a new claim with a new sick note (and perhaps a letter) from your GP to confirm this.

You have a right to ask for the Department for Work and Pensions to reconsider their decision or ask that your case be heard by an appeal tribunal. Act quickly if you wish to do this as the time limit for challenging decisions is normally only one month. Advice on challenging decisions is available at 'A Guide to Challenging Department for Work and Pensions Decisions'.

If you want to know more about benefits contact your local office of Tameside Council's Customer Service - Telephone - 0161 342 8355

A directory of information and advice providers is available at www.clsdirect.org.uk or you can telephone 0845 345 4345 (Minicom 0845 609 6677)

We have made every effort to ensure that the information is correct at the date shown at the bottom of the page, however, changes in the law or practice may make this leaflet become gradually less accurate over time.