What is Incapacity Benefit?

Incapacity Benefit is a benefit for people unable to work because of an illness, impairment or because they are disabled. Incapacity Benefit is not means-tested but to qualify you must have paid enough National Insurance contributions. Incapacity Benefit should be claimed if you cannot get Statutory Sick Pay or if Statutory Sick Pay has ended.

For the first 28 weeks you are sick you will be entitled to claim if you are unfit to do your own job. This rule will only apply if you have done the same job for eight out of 21 weeks.

There are three rates of Incapacity Benefit:

• the short term lower rate paid for the first 28 weeks
• the short term higher rate paid from week 29 to week 52
• the long term rate paid after week 52, or from the date you claim if you receive higher rate care component of Disability Living Allowance (DLA)

After 28 weeks sick from your own job (unless exempt) you will have to satisfy the "Personal Capability Assessment".

People who are exempt from the Personal Capability Assessment

The following are exempt:

• people receiving Disability Living Allowance - higher rate care
• people who are terminally ill with a progressive disease
• people who are registered blind
• people with a Disablement Benefit of 80 per cent or more
• pregnant women within six weeks of confinement
• pregnant women where there is a serious risk to her or her child
• people receiving in-patient treatment in hospital
• welfare to work beneficiaries
• exemption on "specified medical condition" 

For further information contact your local social work office.

Mental Health

One of the specified medical conditions relating to mental health states:

A severe mental illness is one which "severely and adversely affects a person’s mood or behaviour and which severely restricts their social functioning, or awareness of their immediate environment".

Guidance advises that a mental health problem should be considered "severe" where there is a need for ongoing psychiatric care - for example:

• sheltered residential facilities with regular medical or nursing supervision
• day care at least one day per week in a centre where qualified nursing care is available
• care at home with intervention, at least one day a week, by a qualified mental health care worker
• long-term medication with anti-psychotic drugs including depot neuroleptics or mood modifying drugs

Exemption should also be considered where your condition severely restricts your social functioning or means you are likely to pose a threat or danger to others.

What medical evidence can I use?

Medical evidence can be from:

• a doctor approved by the Secretary of State
• any other doctor, hospital or similar institution, or
• the most reliable evidence available in the circumstances

What is the "Personal Capability Assessment" (previously the "All Work Test")?

The "Personal Capability Assessment" applies from the first day of incapacity for which you claim, unless you recently worked. If you are not exempt you will be sent a questionnaire called an IB50 which you must fill in and return within six weeks. You must be sent a reminder after four weeks. Along with the questionnaire you should have a form Med 4. This form should be completed by your GP and should state all your health problems.

The questionnaire is intended to ask about your ability to do certain tasks. The main part of the form is to describe your physical activities and the difficulties you experience. The last part is to describe any mental health problems, and how this affects you on a daily basis.

In the questionnaire you are asked to tick boxes that match the level of difficulty you have completing these tasks. You will be scored depending on how much difficulty you have with each task. To get benefit you need 15 points if you have difficulty with physical activities, or ten points if you have mental health problems or a combination score in both areas.

What  if I am asked to attend a medical examination?

You may be asked to attend a medical examination. You should be given seven days notice to attend. You can take someone with you. If you cannot attend you should contact Jobcentre Plus to arrange another date. If you do not attend a medical examination you will be treated as capable of work and benefit will be revised on that day unless you can show "good cause" for not attending.

What happens at the examination?

The doctor will assess you from the time you enter the waiting room until you leave. The doctor will ask questions about your everyday activities and relate these to the questionnaire, and may examine you. This will normally last around 20 minutes. The doctor will then pass a report on to the Decision-Maker that decides your entitlement to benefit.

What if I am found capable of work?

If you are found capable of work, it will normally be from the date of the medical examination. If you disagree with the decision you should continue to submit medical certificates and send in an appeal letter within one month of the date on your decision.

While you are appealing, you can sign on as available for work and claim Jobseeker’s Allowance. This will protect your entitlement to National Insurance contributions and will not affect the outcome of the appeal.

If you do not wish to claim Jobseeker's Allowance, you can claim Income Support. However, this will be paid at a reduced rate.

What if I fall ill again?

If you submit a new claim within six months with another medical problem, medical certificates will cover you as incapable of work until you are next assessed under the "Personal Capability Test".

If you re-claim within six months and the Decision-Maker decides your condition is the same, you will not be accepted as incapable of work while awaiting an assessment under the "Personal Capability Test".

If you re-claim quickly, the Decision-Maker may decide that you fail without a further questionnaire or examination.

What happens if I appeal?

You must appeal within one month of the date on your decision. You also have an opportunity to get further medical evidence either from your GP or other health worker. For more advice on obtaining medical evidence contact your local social work office.  

The appeal tribunal will look at your whole case again and a representative from social work can attend the appeal tribunal with you. If successful, benefit can be reinstated from the date it stopped.

If you require assistance with completing an IB50, need advice about submitting new claims or require representation at an appeal tribunal, please contact your local social work office.
            

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