About Illness Benefit, Invalidity Pension, Disability Allowance, Supplementary Welfare Allowance & Appeals
(Please check for regular HSE Support updates at the end of the post which we will add as they occur)
Illness Benefit
Whether your employer pays you, or not, while you are out sick from work, you can apply for Illness Benefit which is a weekly payment. Illness Benefit is not linked to your employer's policy on pay for sick leave. However, if you get sick pay from work and Illness Benefit, you should ask your employer about any arrangements in place for this.
To qualify for Illness Benefit, you must:
- Be aged under 66
- Be medically certified as unfit for work by a medical doctor (GP).
- Have enough social insurance (PRSI) contributions – see below.
- Apply within 6 weeks of becoming ill.
Illness Benefit is paid for a maximum of:
2 years (624 payment days) if you have at least 260 weeks of social insurance contributions paid since you first started work
Or
1 year (312 payment days) if you have between 104 and 259 weeks of social insurance contributions paid since you first started work
Important to note:
Before your Illness Benefit payment is due to stop (max two years) you will be contacted by the Department of Social Protection (DSP) telling you when your payment will stop and giving you information on your options, for example:
Our advice is that you make a note of when your illness benefit is due to end when you first receive it and think about completing your application for either Invalidity Pension or Disability Allowance a few weeks/months before Illness Benefit is due to end, so that there is continuity of payments while you are not working, and because it can take a long time to get the follow-up payment you may be entitled to.
If you are ill and likely to be permanently incapable of work and satisfy the PRSI conditions, you may get Invalidity Pension
If you do not get Invalidity Pension and you have a disability that is expected to last for a year or more, you may get a Disability Allowance
If you do not qualify for any other payments and your income is too low to meet your needs, you may get a Supplementary Welfare Allowance
Your Illness Benefit claim will be reviewed from time to time and you may be asked to attend for a medical assessment. This assessment will be carried out by a Medical Assessor, who is a doctor employed by the Department of Social Protection. The Medical Assessor will give their opinion on whether you are fit for work. You must attend for a medical assessment when asked, or your Illness Benefit will be suspended.
If your Illness Benefit is stopped, you have a right to appeal the decision. If you are getting credited contributions only and these are stopped, you can seek a review of the decision, but you do not have a right to appeal it.
Rate of Illness Benefit
Your Illness Benefit rate will depend on your average weekly earnings in the relevant tax year. Average weekly earnings are your gross earnings (without deductions) in the relevant tax year divided by the actual number of weeks worked in that year. Usually, no payment is made for the first 3 days of illness.
How to Apply for Illness Benefit
You must apply for Illness Benefit within 6 weeks of becoming ill.
If you don't apply within 6 weeks you may lose some of your payment. If there is a good reason for a delay in applying, your payment may be backdated.
Paper application form:
You must get an Illness Benefit claim form (IB1) and a medical certificate called a ‘Certificate of incapacity for work’ from your family doctor (GP). You fill in the IB1 form and freepost it to the Department of Social Protection - see 'Freepost' address below.
Your GP can provide one medical certificate to cover the duration of your illness. Some GPs can complete the medical certificate online. If your GP cannot send it online, you will get a paper medical certificate which you must fill in with your personal details and freepost it with your IB1 form to the Department.
You do not pay for the ‘Certificate of incapacity for work’ as the Department pays the doctor an agreed fee. However, you may have to pay for the doctor to examine you.
Hospital certs: if you are or have been an in-patient in a hospital, you should ask a hospital doctor to give you a pro forma letter which you can bring to your GP who then gives you the claim form (IB1) and medical certificate (Certificate of incapacity for work) with no charge. If you’re still in hospital, a family member can bring the pro forma letter to your GP on your behalf.
Freepost
Completed claim forms (IB1) and medical certificates (Certificate of incapacity for work) should be sent by Freepost to: Social Welfare Services, P.O. Box 1650, Dublin 1.
Appeals
If you think you have been wrongly refused Illness Benefit, you can appeal the decision to the Social Welfare Appeals Office. You should appeal within 21 days of getting the decision.
Where to appeal
Illness Benefit
Department of Employment Affairs & Social Protection
P.O. Box 1650
Dublin 1
Ireland
Tel: (01) 704 3300 or 0818 928 400
Email: illnessbenefit@welfare.ie
Invalidity Pension
Access the Invalidity Pension Application Form via links above.
Invalidity Pension is a weekly payment to people who cannot work because of a long-term illness or disability and who are covered by social insurance (PRSI).
To qualify for Invalidity Pension you must meet both:
· Social Insurance (PRSI) rules
· Medical rules
You must have at least:
260 (5 years) paid PRSI contributions
48 weeks of paid or credited PRSI contributions in the last or second last completed year before the start date of your permanent incapacity for work. The start date is decided by the Department of Social Protection (DSP). It is usually after you have been unable to work for one year. But it can be less than one year if you are permanently incapable of work for life.
To meet the medical rules, you must:
Have been incapable of work for at least 12 months and be likely to be incapable of work for at least another 12 months (you may have been getting Illness Benefit or Disability Allowance during that time)
Or
Be permanently incapable of work (in certain cases of very serious illness or disability, you can transfer directly from another social welfare payment or from your job to Invalidity Pension).
A Deciding Officer in the DSP will decide if you meet the medical and PRSI rules for Invalidity Pension.
To apply for Invalidity Pension
Fill in an Invalidity Pension application form (INV1) (pdf). You can get a form from your Intreo Centre or Social Welfare Branch Office.
You can apply for Supplementary Welfare Allowance while you are waiting for your Invalidity Pension claim to be processed. SWA is a means tested payment. In a means test the Department of Social Protection examines all your sources of income. To get SWA, your income must be below a certain amount.
More about Invalidity Pension
HSE: https://www.gov.ie/en/service/d148b9-invalidity-pension/
Citizen’s Information: https://www.citizensinformation.ie/en/social_welfare/social_welfare_payments/disability_and_illness/invalidity_pension.html#:~:text=for%20Invalidity%20Pension-,What%20is%20Invalidity%20Pension%3F,Invalidity%20Pension%20is%20taxable.
Disability Allowance
HSE: https://www.gov.ie/en/service/df6811-disability-allowance/
Citizen’s Advice: https://www.citizensinformation.ie/en/social_welfare/social_welfare_payments/disability_and_illness/disability_allowance.html
Access Disability Allowance Application Form via links above
Disability Allowance (DA) is a weekly allowance paid to people with a disability. You can get DA from 16 years of age. You can get Disability Allowance even if you are in school.
To qualify for Disability Allowance you must:
Have an injury, disease or physical or mental disability that has continued for at least one year or is expected to continue for at least one year
Be substantially restricted because of your disability from doing work that would be suitable for a person of your age, experience and qualifications
Be aged between 16 and 66.
Pass a means test – a means test looks at any income that you have – see ‘How your income is assessed for DA’ below
Live in Ireland and meet the habitual residence condition
If you qualify for DA, you may also get extra social welfare benefits with your payment and other supplementary welfare payments.
Medical assessment
Your doctor must complete a report on your medical condition as part of the application form. This report is reviewed by one of the DEASP’s medical assessors.
The medical report will allow the DEASP to determine if you:
Have an injury, disease or physical or mental disability that has continued for at least one year or is expected to continue for at least one year.
DA is a means-tested payment. In a means test the Department of Employment Affairs & Social Protection examines all your sources of income. To get DA, your income must be below a certain amount. But your parent’s income is not taken into account when you are assessed for Disability Allowance.
More information on Disability Allowance via links below:
Citizen’s Advice:
Our Advice for Anyone Applying for or Appealing Invalidity Pension or Disability Allowance
It can take several months to be processed for either Invalidity Pension or Disability Allowance and many have to go through an appeal process after being initially turned down. Feedback from people in the ME community shows a high failure rate on the first claim for Invalidity Pension and in many cases on the first claim for Disability Allowance. It is worth assuming that you will be refused and start preparing for your appeal soon after you have made your initial application, collecting any new evidence and supporting documentation, to include any new relevant test results and doctors reports or supporting letters confirming diagnosis and chronic illness.
A high percentage are turned down on first application. A good percentage pass an appeal. Why? They want to lose you on the initial application but can’t ignore the facts if you keep on their case.
Our advice is that:
- You get a strong letter of support from your consultant(s) and occupational therapist to confirm that you will be incapable of work for an indefinite length of time, i.e., longer than 12 months, because of the chronic disabling nature of ME.
- You include completed documents such as the De Paul Questionnaires on Symptom, Symptom Severity and PEM, as well as completed Bells Disability Scale. Please find all above mentioned questionnaires here
- You could gather up all recent MRI, CT and x-ray reports no matter how relevant they are. Add very single report from all consultants/specialists and bind them in a folder. Write a letter with it too with description of how you are, what the outcome was from the scan/report and annex it. For Example, Annex A - first CT scan and date. Add any report associated with your scan. Annex B- Brain MRI and the report, and so on depending on medical records you may have.
Include everything, no matter how small you might think its relevance.
- You add a list of all the prescription meds and all the supplements you are taking.
- You include a brief ‘before and after illness Journal describing how you were before illness, i.e., work/hobbies/activities/health, and how you are now with chronic illness, giving an account of your worse day and the disabling symptoms.
Remember some people with Myalgic Encephalomyelitis (ME) can experience fluctuating illness, seeing a relatively moderate day and then following activity seeing horrendous days, don’t forget your worse days when getting across how debilitating and disabling ME is, i.e. the debilitating symptoms and features of your ME that prevents you from activity and deems you unfit for work.
- You could add another supporting document called ‘My Needs Statement’, more here
- You could add detail re the various treatments/therapies you have tried over the past months/years (which could be considerable). That way you are providing evidence of your attempts to get better and ambition to return to work, as well as showing how ill you are.
- You could add a letter from your GP pointing out that because of your symptoms you are unable to work...this can work better than ‘because of her ME she can’t work’ as ME may not be recognised but your disabilities and disabling symptoms that prevent you from being active would be taken into account i.e., the list of debilitating symptoms that prevent you from working in any job.
- You could ask for an oral interview which will show that you mean business and are prepared to show yourself.
Other patients have reported success at appeal stage after approaching a local representative for support.
- You could include a consultant’s letter stating a confirmed diagnosis and outlining inability to work indefinitely and explanation of why you are unable to work.
If you don’t see a specialist then the GP needs to make a stronger case that ME is relentless and specifically that there’s no cure. The main line is that the illness is chronic, and patients suffer for decades. Then personalise it to say you’ve struggled with ME for a long time and pushed through but haven’t been able to work for a while and won’t indefinitely. No one can decide when you are better.
We’ve noticed in feedback from patients that their doctor or consultant can say things in a letter like ‘has improved’ on such and such a drug; that definitely does not help so leave anything like that out of the file you send them. Improvements in ME are mostly temporary because of the fluctuations in ME.
The bottom line is that with ME we see ourselves having ‘good’ days and bad days. You need to describe your absolute worst day because though we have ‘good’ days we know the bad days come and that’s only what they need to hear about. Don’t give them any positives whatsoever. Give an inch they take a mile! Give a very clear and concise outline of your typical worst day and your struggles with regards to activity, mobility etc.
We’ve heard of people regularly ringing the Dept of Social Protection to keep on top of the progress of the application or appeal. Keep on them and let them know you are not going away.
We have also heard that a patient's local representative (TD) can make those calls too on your behalf especially if you’re not up to it.
At the end of the day the welfare system is actually much fairer than the private Insurance one, and with a bit of persuasion you can get around the welfare one.
Citizens Information are very helpful with the application process and an appeal.
Don’t give up - don’t let the first decision to refuse you welfare put you off, it is important to fight for your right to financial support and appeal the decision. The Department of Social Protection appear to try to lose people early in a process, but they may eventually recognise proof of illness and disability, and award applicants following an appeal.
Remember that when you are refused supports it is not personal, it’s the system trying to put people off and not pay them. You are just a statistic, and the deciding officer has no idea of your hell. Appeal the decision and get a medic to support you in a letter stating you were in a particular profession and why you can’t work to that profession citing some of the duties of that profession as examples.
You may have limited time to make an appeal, please check the letter of refusal you received. More on Appeals below
Checklist When Appealing A Social WelfareSocial W
Checklist When Appealing A Social Welfare Decision There are a number of stages involved in the appeal process. This checklist from ‘Thinking Disabilities’ outlines these stages and explains the process involved in making an appeal to the Social Welfare Appeals Office.
Supplementary Welfare Payments
You can apply for Supplementary Welfare Allowance (SWA) while you are waiting for your Invalidity Pension/Disability Allowance/Appeal to be processed. SWA is a means tested payment. In a means test the Department of Social Protection examines all your sources of income. To get SWA, your income must be below a certain amount. You can contact your local community welfare officer to receive that ‘emergency money’ while you are waiting for the outcome of an application and/or appeal.
Supplementary Welfare Allowance (SWA): List of offices administering SWA:
More Information on Welfare Payments
From the webinar “Social Welfare –Disability Allowance & Invalidity Pension” thanks to the Irish ME Trust
The Equality Act says no one should be discriminated against because of their disability - excluding someone because they have an ‘ME’ label rather than another ‘acceptable’ label would seem not to be lawful, though a case would need to be brought and a judgement made so there was case law to rely on.
Updates
09/02/23
With regards to Disability Benefit, Invalidity Allowance, etc there is no harm in letting the Department of Social Protection know that our HSE is not excluding anyone based on the name of their illness, which strongly suggests they too should be assessing against need not name.
For anyone told ‘ME is not on our list of disabilities’ here is a response from National Community Operations here, received on 09/02/23
1) ‘Services are provided on the basis of assessed need rather than diagnosis and take into account the individualised requirements of people’ is a standard now stated which if your area is not complying with the national standard by denying an assessment because ‘ME is not on the list of disabilities’ you can quote the national position dated 09/02/23 to them and ask why they are not adhering to it, copy National Director Yvonne O’Neill into your email: communityoperations@hse.ie
Ask for the policy and Servce User information from your CHO area manager so you know what to expect from a service.
More on National Framework for Developing Policies, Procedures, protocols and Guidelines here
There has been significant work undertaken to enable people with chronic illness to live their lives at home, it is however recognised that these services are available to all patients. The HSE provides Personal Assistants and Home Support Services as well as Respite Services and Therapeutic Supports, and Aids and Appliances, that are designed to enable people to live as independently as possible. Services are provided on the basis of assessed need, rather than diagnosis, and take into account the individualised requirements of people.
29/05/23
ME Advocates Ireland (MEAI) would like to collate anonymised feedback from their new informal survey to update the information post on Social Welfare in Ireland, and to use when communicating with the HSE.
Please complete the survey only if (i) you live in Ireland and (ii) have applied for a Welfare Payment in Ireland because of your illness and disabilities associated with Myalgic Encephalomyelitis (ME), or if you are a carer who has applied on behalf of someone with ME in Ireland. We will share the feedback from the survey on here next month.
Post on Public and Community Health Supports and Services here
Post on Mobility Aids and Appliances - Mobility Scooter and Powered Wheelchair etc here
Disclaimer: The information in this post is for general information purposes only. While we endeavour to keep the information up to date and correct, we make no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, suitability or availability with respect to the post or the information, products, services, etc contained in the post for any purpose. Any reliance you place on such information is therefore strictly at your own risk.The suitability of any solution is totally dependent on the individual. It is strongly recommended to seek professional advice and assistance.
