About Illness Benefit, Invalidity Pension, Disability Allowance, Supplementary Welfare Allowance & Appeals
Illness
Benefit
HSE: https://www.gov.ie/en/service/ddf6e3-illness-benefit/#how-to-qualify
Citizen’s
Information: https://www.citizensinformation.ie/en/social_welfare/social_welfare_payments/disability_and_illness/disability_benefit.html#l30369
Access the Illness Benefit Application Form via links above.
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
Homepage: https://www.gov.ie/en/service/ddf6e3-illness-benefit/
Email:
illnessbenefit@welfare.ie
For more
about Illness Benefit see
HSE: https://www.gov.ie/en/service/ddf6e3-illness-benefit/#how-to-qualify
Citizen’s Information: https://www.citizensinformation.ie/en/social_welfare/social_welfare_payments/disability_and_illness/disability_benefit.html#l30369
Disability Allowance and Invalidity Pension
Invalidity
Pension
HSE: https://www.gov.ie/en/service/d148b9-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.
More
about Invalidity Pension
HSE: https://www.gov.ie/en/service/d148b9-invalidity-pension/
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:
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
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.
- If you are asked to do an oral interview get your doctor to support you and say you are not well enough to attend an interview.
Other patients have reported success at the appeal stage after approaching a local representative for support. You could get onto one of your TDs and explain what’s happening and ask for their support. You can do this by phone or email though a phone call may be better. If you are not up to making the call get someone else to make a call on your behalf.
-
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.
I’ve noticed
that in the past my own consultant can say things in a letter like ‘has
improved’ on such and such a drug and 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.
I’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.
I have heard
that your 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:
- Post on Public and Community Health Supports and Services here
- Post on Mobility Aids and Appliances - Mobility Scooter and Powered Wheelchair etc here
- The Disability Legal Information Clinic, run by the Centre for Disability Law and Policy in NUI Galway provides free, accessible, confidential legal information on disability related legal issues and is available right across Ireland for disabled people, their families and supporters. The clinic is staffed by law student volunteers who are supervised by a member of the CDLP team and a qualified legal practitioner. In the past the clinic has dealt with issues in relation to housing, education, employment, discrimination and access to supports or services. To find out more about the clinics work visit the website here. You can also email dlic@nuigalway.ie if you have any questions or would like to arrange an appointment.
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