A Guide to Incapacity Benefit which gives financial help to people who are not working because they are sick or disabled.
See also: Benefit Rates
Note for new claimants: Since 27 October 2008, Incapacity Benefit and Income Support that is paid because of an illness or disability for new claimants has been replaced by Employment and Support Allowance.
Introduction:
Reassessment of claims:
People who receive Incapacity Benefit, on the grounds of illness or disability will be assessed for Employment and Support Allowance.
People who are capable of work will move onto Jobseeker’s Allowance where they satisfy the conditions of entitlement for that benefit.
People who need more support while they prepare for work will get that help on Employment and Support Allowance (ESA).
Those people who are most disabled or terminally ill will not be expected to look for work and will get the extra support they need on ESA.
The change will not affect:
People who are already being paid Employment and Support Allowance and people who reach state pension age before 6 April 2014.
Incapacity Benefit can be paid to people based on the number of National Insurance contributions they have paid or been credited, or may be claimed under the youth provisions if they were sick or disabled when they were 16 or over but under 20 (25 if they were in education or training before age 20).
People who have reached state pension age cannot normally get Incapacity Benefit. State pension age is currently 60 for a woman and 65 for a man. This will be equalised at 65 for both men and women from 6 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. If you cannot get Incapacity Benefit, you may still be able to get National Insurance credits for each full week 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, see leaflet SD1. If you were getting Invalidity Benefit when it was replaced by Incapacity Benefit in April 1995 or were getting Incapacity Benefit before 6 April 2001, your claim may be covered by transitional protection. This means that your entitlement to Incapacity Benefit may be based on different rules.
The guide below covers
What is Incapacity Benefit
Do you qualify
Payment rates
If you have personal pension
How to Claim
How is your incapacity assessed
When does the Own Occupation Test apply
When does the Personal Capability Assessment apply
Exemptions
How much do you get
Does anything affect what you get
New permitted work rules from April 2002
Transitional Rules
Linking rules
What happens on retirement
How are you paid
Reviews and Appeals
Further information
What is Incapacity Benefit?
Incapacity Benefit is for people unable to work because of illness or a disability. It is paid if Statutory Sick Pay (SSP) has ended, or if you cannot get SSP (SSP is paid for the first 28 weeks of sickness). IB is not paid if you were already over state pension age when you became sick.
You must have paid enough National Insurance contributions to qualify.
It is not means-tested, so the amount you receive does not depend on your income or savings. However, if you make a new claim to IB for a date on or after 6th April 2001, you will have any gross Pension Income taken into account when the payable rate of benefit is being calculated.
Incapacity Benefit replaced Invalidity and Sickness Benefit from 13 April 1995. People getting Invalidity Benefit (IVB) or Sickness Benefit at the time of the changeover were automatically transferred onto Incapacity Benefit and the amount of benefit, they were receiving at the time was not affected.
Do you qualify?
You qualify for short-term Incapacity Benefit if you:
have paid National Insurance contributions and
you are ‘incapable of work’ or are in a ‘period of incapacity for work’.
If you have been incapable of work because of sickness or disability for at least 4 days in a row including weekends and Bank Holidays, and
cannot get statutory sick pay
you are under state pension age (65) or
you are no more than 5 years over state pension age, your ‘period of incapacity for work’ began before pension age, and you would be entitled to retirement pension if you claimed it.
If you are aged under 20 you may be able to get IB even if you have not paid enough National Insurance contributions, provided you have been sick for at least 28 weeks without a break.
The same applies if you are aged 20 or over but under 25, and you were in education or training for at least 3 months before your 20th birthday.
Payment rates
There are several different rates of IB
For the first 28 weeks of incapacity you can get the short-term lower rate. After 28 weeks on the lower rate, you move onto the short-term higher rate. This is paid from week 29 to week 52. After 52 weeks, the long-term rate becomes payable.
Short-term IB at the lower rate will be paid if
you do not get SSP and have been sick for at least 4 days in a row including weekends and bank holidays, or if you qualify under the special rules for young people.
Short-term IB at the higher rate will be paid if
you have been sick for more than 28 weeks and less than 52 weeks. If you qualify under the special rules for young people you must have been getting lower rate IB for 28 weeks.
Long-term IB will be paid if
you have been sick for more than 52 weeks. If you qualify under the special rules for young people, you must have been getting short-term IB for 52 weeks.
If you get the highest rate care component of Disability Living Allowance (DLA) or you are terminally ill, you will get IB paid at the long-term rate after you have been sick for 28 weeks.
If you qualify under the special rules for young people and you get the highest rate care component of DLA or you are terminally ill, you will get IB paid at the long-term rate after you have been getting IB for 28 weeks.
See: Benefit Rates
What else do I need to know?
If you are under 20 (25 if you have been in education or training) you may be able to get IB even if you have not paid NI contributions.
If you have recently come from abroad, or returned from abroad, there are some extra rules. You may be treated as having paid the necessary National Insurance contributions to get IB if you have:
Been working abroad for an employer based in the United Kingdom and paid NI contributions for the first 52 weeks of that employment, or
Paid enough UK NI contributions and the equivalent of NI contributions in certain other countries.
If you became sick before reaching pension age, you may be able to get IB after pension age. It can be paid at the Retirement Pension rate for up to one year of sickness.
If you get the long-term rate of IB you may qualify for extra money depending on your age when you became sick. You may get Incapacity Age Addition if you get long-term IB and were aged under 45 on the day you became unable to work. This includes days you got Statutory Sick Pay.
If you have a personal pension
For new claims, half of your occupational or personal pension(s) above £85 is to be deducted from your incapacity benefit. For example, if you have a weekly occupational pension of £95 then your incapacity benefit will be reduced by £5 a week.
It is intended that permanent health insurance payments arranged through your employer will also be taken into account after your employment has ended.
The government has said you will be exempt if:
You already get incapacity benefit at the time the rules change – see below;
Your claim links back to an earlier incapacity benefit award that ended before the rules changed (contact the Benefits Agency to learn about the special linking rules for work and training;
You get disability living allowance higher rate care component;
The pension payments are in connection with the death of a member of the scheme.
It is expected that the rules will treat you as having an income from an occupational pension that would be available to you if you applied for it. So you can avoid the reduction by deferring part of your pension. But this wil not pply to personal pensions unless you are aged 60 or over
How to claim:
You claim using the Incapacity Benefit claim pack, SC1, available from:
A doctor’s surgery
Hospital
Department of Social Security (DSS)
You should send this form to your local DSS office after 4 days of sickness. For the first seven days you do not need a medical certificate. If you are incapable of work for more than seven days, you must also send a medical certificate (form Med 3) from your doctor. If you have worked in the same job for at least eight of the last twenty six weeks, for the first 28 weeks of your incapacity for work you will be assessed under the ‘Own Occupation Test’.
If you have not worked recently, or after you have been incapable of work for 28 weeks you will have to go through the personal capability assessment. This tests your ability to do any kind of work. If you score enough points on this test you will be accepted as incapable of work.
The Benefits Agency will write to your GP for information about your mental health problem. On the basis of the letter, the Benefits Agency will decide whether your mental health problem is severe or less severe.
If they decide that you have a severe mental health problem, you will be awarded Incapacity Benefit.
If they decide that you have a less severe mental health problem, you will be sent a questionnaire, which asks you what physical problems you have.
If you have a mental health problem, you will need to write about your health problems in the special section (self-assessment questionnaire) on the claim form. You will be asked to attend a medical examination by a Benefits Agency Doctor, so that an additional mental health assessment can be carried out.
Backdating claims – You can send in your claim form up to three months after the first day for which you wish to claim. Ask your doctor for a backdated medical certificate, form Med 5. Your claim cannot be backdated for longer than this.
Work Tests:
Your ‘incapacity for work’ must be ‘by reason of some specific disease or bodily or mental disablement’. There are two tests of incapacity:
the ‘own occupation’ test which looks at your ability to do your usual job if you’ve worked recently.
the personal capability assessment, which assesses your capacity to do any work. The test looks at your ability to carry out a range of activities such as working, standing, and sitting, and includes an assessment of mental health where appropriate.
When does the ‘own occupation test’ apply?:
If you have worked in one occupation for more than 8 weeks out of the last 21 weeks before the first day for which a decision on incapacity needs to be made. The work you do must be for at least 16 hours per week. The 8 weeks do not need to be consecutive. You can be employed or self-employed provided you are paid or the work is done in expectation of payment. If you make a fresh claim for benefit before the 196 days are up, and the break between claims is less than 8 weeks, the own occupation test will continue to apply for the remainder of the linked spell of 196 days.
When does the ‘personal capability assessment’ apply?:
If the ‘own occupation test’ does not apply i.e. you have not worked for more than 8 weeks in the last 21 weeks; the personal capability assessment applies from the first day of incapacity for which you claim. This assessment will also be applied after 28 weeks (196 days) of Incapacity Benefit. Until you are assessed under the personal capability assessment, you must continue to send in medical certificates.
Exemptions:
You are exempt if there is medical evidence that you are suffering from any one of the following conditions:
severe learning disability – this is defined as a ‘condition which results from the arrested or incomplete physical development of brain, or severe damage to the brain, and which involves severe impairment of intelligence and social functioning’ (this is less restrictive than the ‘severe mental impairment’ test for DLA component in that it includes conditions such as head injury which arise later in life.
severe and progressive neurological or muscle wasting disease (e.g. Huntington’s chorea)
severe mental illness involving the presence of mental disease which severely and adversely affects mood or behaviour, and severely restricts social functioning or awareness of immediate environment.
You are also so exempt if you get DLA higher rate care component, or constant Attendance Allowance (intermediate or exceptional rate)
Extra exemptions if you have been incapable of work since before 13 April 1995 include:
you were aged 58 over on 13 April 1995 and were entitled to Invalidity Benefit between 01.December 1993 and 12 April 1995 (breaks off benefit of 8 weeks or less are allowed)
Does anything else affect what you get?:
Other Benefits
You cannot get Incapacity Benefit as well as Retirement Pension or Jobseeker’s Allowance. Other benefits such as maternity allowance, severe Disablement Allowance, Invalid Care Allowance and Unemployment supplements are known as overlapping benefits. You can receive an amount equal to the highest of these benefits.
Other benefits that can be paid on top include:
Disability Living Allowance
Attendance Allowance
Disablement Benefit
If you were claiming Income Support, Housing Benefit or Council Tax Benefit because of incapacity, you will continue to get the disability premium paid with these benefits for as long as you remain incapable of working.
Other Income
Incapacity Benefit is not means-tested so it is not affected if you receive
wages or an occupational pension or sick pay while you are off sick.
Work
Generally if you do any work you are treated as capable of work and thus cannot get Incapacity Benefit.
But you are allowed to do some kinds of work and still receive Incapacity Benefit or Severe Disablement Allowance, or still be counted as incapable of work for other purposes e.g. Disability Premium. An Adjudication Officer at the Department of Social Security (DSS) makes the decision on whether or not the work you do is allowed.
New permitted work rules from 8 April 2002:
From 8 April 2002 there are new rules if you want to try some paid work while getting Incapacity Benefit, Severe Disablement Allowance, National Insurance Credits or Income Support because of illness or disability. The new rules are called the permitted work rules and the work is called permitted work.
If you were already doing therapeutic work when the rules changed, you may be able to carry on doing it until April 2003. After that you can consider doing permitted work straight away under the new rules.
The new arrangements allow you to try some paid work without the need for prior approval from a doctor, but you should tell the office that pays your benefit before you start work.
You can work:
for earnings of up to and including £20.00 a week for an unlimited period, or
for less than 16 hours a week, on average, with earnings up to and including £67.50 a week for a 26 week period. The period can be extended for another 26 weeks if a Job Broker, Personal Adviser or Disability Employment Adviser agrees that it will help you towards work of 16 or more hours a week. There is no limit to the number of times you can do permitted work in this category while you are getting incapacity benefit; but there must be a gap of at least 52 weeks between periods. These subsequent periods are for 52 weeks and a Job Broker, Personal Adviser or Disability Employment Adviser must support the work from the outset.
in supported permitted work for earnings of up to and including £67.50 a week for an unlimited period.
Supported permitted work is work done with the ongoing support or supervision from a professional caseworker (employed or engaged by a public body or voluntary organisation). This could be work done in the community or in a sheltered workshop. It also includes work done under medical supervision as part of a hospital treatment programme.
You do not have to undergo a medical test just because you are doing permitted work. However, if a medical test is due it will go ahead as planned.
You can carry on getting Incapacity Benefit or Severe Disablement Allowance while doing permitted work without it affecting your benefit. If you get Income Support, Housing Benefit or Council Tax Benefit your benefit will be reduced if your average earnings are more than your earnings disregard.
Voluntary work:
You can do as much voluntary work as you like. Your Incapacity Benefit will not be affected as long as you do not receive any pay other than expenses.
The voluntary work must not be for a close relative.
You must tell your social security office if you do any voluntary work, and if you are paid in any way.
Permitted expenses could include:
Travel
Childminding or the costs of caring for another dependent
Equipment needed for work
Use of a telephone
Meal vouchers
Transitional Rules:
There are transitional rules that protect the amount of benefit you get if you transferred to Incapacity Benefit from invalidity benefit and sickness benefit.
But you must pass the personal capability assessment unless you are exempt.
Transferred from Invalidity Benefit?
If you were entitled to Invalidity Benefit on 12.04.95, your benefit automatically became a ‘transitional award of long-term Incapacity Benefit.’ If your invalidity benefit stopped at any time between 15.02.95 and 12.04.95 and you became incapable of work again no more than 8 weeks after your last day of incapacity in that period, your new award is also a transitional award of long-term Incapacity Benefit.
Transferred from Sickness Benefit?
If you were entitled to sickness benefit on 12.04.95, your award automatically became a ‘transitional award of short-term Incapacity Benefit’, paid at the same rate as ordinary short-term Incapacity Benefit.
A transitional award ends when you move onto a long-term benefit. If you are getting sickness benefit because of an industrial accident or disease you can move on to long term Incapacity Benefit even if you don’t satisfy the contribution conditions.
Linking Rules:
There are linking rules which theoretically help people to restart benefits without losing out after a trial period at work.
This means that if you are off work because of illness or disability within 8 weeks of the end of your last incapacity benefit payment, the two periods of incapacity for work can sometimes be linked together to form a single period, and you will go back onto the benefit at the same rate and same terms as before. Ask for advice about this before starting work to find out how you can protect your rights; in practice these rules have been found to be problematic.
8 week linking rule
If you are off work because of illness or disability within 8 weeks of the end of your last incapacity benefit award, you’ll go back on to benefit at the same rate on the same terms as before. This is because you are still in the same ‘period of incapacity for work’.
52 week linking rule
This linking rule means that, if you have received benefit due to your incapacity for work, you can try out work or training for up to a year but later return to your previous level of benefit. This linking rule applies to claimants who reclaim the benefit within 52 weeks of leaving it for work or training. To quality for the 52 week protection you must:
have been incapable of work for more than 196 days (gaps of up to 8 weeks are ignored)
and
start work or training within one week of entitlement to the incapacity for work benefit ending
and
notify the Benefits Agency within one month of benefit stopping that you have started work or training (even if you have already informed them) and that you want to apply for the 52 week rule.
What happens on retirement?:
Long-term Incapacity Benefit
If you over pension age (60 for women, 65 for men), you cannot normally receive long-term Incapacity Benefit. You can only receive long-term Incapacity Benefit after pension age if:
you are entitled to a transitional award because you were previously entitled to invalidity benefit and
you reached pension age before 13.04.95
Short-term Incapacity Benefit
You can make a claim for short-term Incapacity Benefit up to five years beyond pension age if you are in a ‘period of incapacity for work’, which begun before you reached pension age. (A ‘period of incapacity for work’ is made up of 4 or more consecutive days of incapacity). Or you can stay on short-term benefit beyond pension age rather than draw your pension if you choose.
Points to note:
You cannot get Incapacity Benefit and retirement pension at the same time, so you will not get short-term benefit if you draw your pension.
You don’t have to satisfy the National Insurance contribution conditions for Incapacity Benefit once you reach pension age.
How are you paid?:
Incapacity Benefit is usually paid fortnightly in arrears. The DSS can consider weekly payment if fortnightly payments are causing hardship. If you get a transitional award, benefit is still paid weekly in arrears as before. You may be paid by an order book, by direct credit transfer into a bank or building society, or by giro bank cheque.
Reviews and Appeals:
An Adjudication Officer at the DSS makes the decision on your claim. If you disagree with the decision, you have the right of appeal to an independent tribunal – Social Security Appeal Tribunal – within 3 months of the decision being sent to you. If you don’t agree that you are fit for work it is well worth appealing. While you are appealing, you can ‘sign on’ as available for work for Jobseekers Allowance. This does not prejudice your chance of winning an appeal on incapacity for work. By ‘signing on’ you will protect your right to National Insurance credits, whether or not your appeal is successful.
Further Information:
Welfare Benefits Handbook, published by Child Poverty Action Group, 94 White Lion Street, London, N1 9PF.
Benefits and Mental Health: a guide to the benefits you can claim if you have a mental health problem. Alban Hawsworth, Disability Alliance, February 2001.
Disability Rights Handbook, available from Disability Alliance, 1st Floor East, Universal House, 88-94 Wentworth Street, London E1 7SA.
Rights Advice Line: 020 7247 8763 (minicom available)
Website: www.disabilityalliance.org
DSS Leaflet IB201, Incapacity Benefit, order by telephone on 0800 868 686
Mental Health and Incapacity for Work: an information pack for people claiming Incapacity Benefit, Income Support and Sever Disablement Allowance available from the Department of Social Policy and Social Work, the University of Birmingham, Birmingham B15 2TT.