- Which diseases are prescribed
- Questions arising on a prescribed diseases claim
- Making a benefit claim for a prescribed disease
- The decision on your claim
- Payment of benefit
- Effects of Industrial Injuries Disablement Benefit on other benefits
The law provides for payment of benefits to people who are suffering from certain diseases contracted in the course of certain types of employment. These diseases are referred to as prescribed diseases (PDs) and are listed in Regulations. [Legislation (43)] [Legislation (44)]
A disease or injury is prescribed when it is a risk arising from a person’s occupation and not a risk common to everybody. The Industrial Injuries Advisory Council (IIAC) makes recommendations to the Secretary of State on what diseases the Industrial Injuries Scheme covers. [Legislation (45)]
IIAC will only recommend that a disease be added to the list of diseases covered if it finds that the disease is a risk of nature of the occupation. There is no entitlement to benefit in respect of a disease if it is not listed in the Regulations, or if the person’s job is not listed against the particular disease. But there may be entitlement to benefit under the industrial accident provisions if a disease has been caused as a result of an accident (see Industrial Accidents).
If you are told that you are not entitled to benefit for a certain disease, it does not necessarily mean you do not have the disease for which you claimed. What you are being told is that you do not meet the criteria laid down in law for receiving benefit for that disease.
For example, a coal miner may be refused benefit for chronic bronchitis and emphysema even though he has the disease. However, unless his actual work history satisfied the occupational criteria set out in regulations, he will not be entitled to benefit.
This is especially important for diseases common in the population at large, where some workers would have got the disease whatever job they did.
Which diseases are prescribed
Prescribed diseases are grouped according to their causes. There are four groups of causes, each identified by a letter, and each prescribed disease has a number. The groups are:
- A for a physical cause
- B for a biological cause
- C for a chemical cause
- D for any other cause.
Questions arising on a prescribed diseases claim
The primary questions arising on a prescribed disease claim are:
- Is the disease a prescribed disease?
- Is the disease prescribed in relation to your occupation and work history? This involves considering whether your employment could have caused the disease, and whether the employment was employed earner’s employment
- Are you suffering from the disease, or have you suffered from the disease? This is called the diagnosis question
- Is the disease due to the nature of your employment?
- When was the date of onset of the disease?
- Have you suffered a relevant loss of faculty due to the disease?
Making a benefit claim for a prescribed disease
When to claim
You can make a claim at any time on or after the date you think you contracted the prescribed disease.
If you have any relevant medical evidence send it with your claim form but do not delay claiming by trying to get a fresh report.
Do not delay claiming. If you do you may lose some benefits. This is because Industrial Injuries Disablement Benefit cannot be paid:
- for a period more than 3 months before the date of your claim
- or if you are already in receipt of Industrial Injuries Disablement Benefit for other accidents or diseases, more than one month before the date of claim. [Legislation (51)]
How to claim
You can get a claim form from your Regional Industrial Injuries Disablement Benefit Centre or via the internet at www.gov.uk.
The date of your claim is the date your fully completed claim form is received in an office of the Department for Work and Pensions (DWP) . It is very important that you fill in all the details on the form carefully and return it to your Regional Industrial Injuries Disablement Benefit Centre as soon as possible. There is one claim pack BI100PD for claiming Industrial Injuries Disablement Benefit for all prescribed diseases.
How claims are decided
When you have completed the claim form, return it to your Regional Industrial Injuries Disablement Benefit Centre If you have any medical evidence relevant to your claim, you should send it with the claim form..
You will be sent a written acknowledgement that the claim form has been received.
We may have to contact your employer(s) to confirm:
- your periods of employment
- that your employment was employed earner’s employment
- that you worked with any of the listed tools or in conditions which are relevant for your claim.
If you satisfy the prescription question
Your papers will be referred to medical services and you may be asked to attend a medical examination. [Legislation (52)]
If you are asked to attend a medical examination and you fail to turn up without good cause, your claim will be disallowed. [Legislation (53)]
If you do not satisfy the prescription question
Your claim will be disallowed and we will write to tell you this.
Fast track cases
Claims for prescribed disease D3 and for all other diseases where the person is terminally ill, are treated as fast track cases. These cases are given priority at all times.
Details of the diseases and the qualifying conditions can be found at Appendix 1
About the medical examination
Your medical examination will be carried out by one or possibly two experienced medical practitioners. These doctors are specially trained in industrial injuries disablement matters.
If you can travel, you will be told when and where to go for the examination. You will be told what out-of-pocket expenses you can claim. If you are not fit to travel alone, someone can travel with you. If you are not fit to travel, you can also request an examination at home but you should give full details of why you are unable to attend a Medical Boarding Centre.
The medical examination will be held in private but you may be able to take a companion if the doctor allows it. Occasionally you may be asked if an observer can be present. You can give the doctor any evidence which was not included with your claim form, if you think it will help them to give an opinion on your disablement.
If you have attended a hospital in connection with the disease you are claiming for, the doctor may seek further information from the hospital. Hospital case notes may be requested by the doctor to assist in giving an opinion. The doctor could also ask for a report from your GP.
The doctor will take a statement from you and send a written report to the decision maker based upon the examination and any other medical evidence.
The doctor will advise on:
- whether you are suffering from a prescribed disease, and if so;
- whether you have suffered a loss of faculty from the disease, and if so;
- the level of your disablement and how long it is expected to last.
If the doctor has advised that you are suffering from a prescribed disease he will also advise on the date of onset of the disease.
The doctor will also provide an explanation for the decision maker as to how they arrived at their opinion.
The doctor will also advise if, in their opinion, the disease is due to the nature of your employed earner’s employment. This is called causation.
For some prescribed diseases you will need to have tests before the medical examination.
In claims for occupational deafness, we will arrange for you to have a hearing test to see if you have an average hearing loss of at least 50 decibels in both ears due to damage to the inner ear. In at least one ear this must be due to noise at work. If the doctor advises that you satisfy this test you will then have a medical examination. If not, your claim will be sent back to the decision maker who will consider whether to disallow it.
Chronic bronchitis and emphysema
In claims for chronic bronchitis and emphysema, it may be necessary for you to have a breathing test. If the doctor advises that you satisfy this test you will then have a medical examination. If not, your claim will be sent back to the decision maker who will consider whether to disallow it.
In claims for pneumoconiosis, we will normally arrange for you to have an X-ray of your chest. If the X-ray and other evidence shows that you may have the disease you will then have a medical examination. If the X-ray shows no trace of the disease your claim will be sent back to the decision maker who will consider whether to disallow it.
What is a loss of faculty?
Loss of physical or mental faculty means some loss of power or function of an organ of the body. Loss of faculty can include disfigurement even when this causes no bodily handicap. Whether a loss of faculty results in disability is decided by comparing your condition as a result of the disease with the condition of a normal healthy person of the same age and sex. [Legislation (58)]
What is the date of onset?
The date of onset of a disease is the date you first suffered a loss of faculty from the disease. The date of onset may be earlier than the date that benefit is actually paid from. This is because the date benefit is paid from is governed by time limits for claiming and other criteria. [Legislation (59)]
Degree of disablement
The medical advice or assessment takes account of all disabilities resulting from the disease. Where your disability also results from some other cause which arose before you got the disease, the degree of disablement which would in any event be present due to that other cause is not counted, but the interaction between the two causes is included in the assessment.
For example, an assembly worker who had previously fractured her right arm in a road accident is diagnosed as having prescribed disease A4 (cramp of the hand or forearm) in the same arm.
The doctor considers a gross assessment of disablement for upper limb dysfunction and deducts an amount for the disablement that remains due to the earlier accident.
If your disablement is 11% or more, and some other condition arises after the accident or disease but is not directly caused by it, any increase in your disablement due to the disease as a result of that other cause is also used to work out your disablement.
For example, a man who is diagnosed as having prescribed disease A11 (vibration white finger) has also developed osteoarthritis in one of his fingers at a later date.
The doctor considers an assessment of disablement for upper limb dysfunction and if that assessment is over 11% the doctor adds a further assessment for the extent that the osteoarthritis increases the man’s disability. [Legislation (60)]
Different types of assessment
You may be given a ‘final’ assessment of disablement for life if your disability is assessed as permanent and is unlikely to change. Or where you are likely to make a full recovery the assessment may be final but for a limited period. Or you may be given a provisional assessment for a limited period at the end of which you will be re-examined and your disablement assessed again. [Legislation (61)]
The decision on your claim
After the medical examination your claim will be decided by a decision maker. The decision maker will look at the doctor’s advice and any other available evidence.
Your Regional Industrial Injuries Benefit Centre will write to tell you the decision on your claim, the amount of any benefit you will get and the period for which you will get benefit.
The decision only takes account of your physical or mental condition it is not related to whether or not you are capable of work. It can be paid whether or not you have returned to work and it does not depend on your earnings.
Loss of earnings and other circumstances may, however, mean you can get one or more of the other benefits described later in this guide.
If you disagree with the decision
Payment of benefit
How much benefit you will get
The amount of benefit you get depends on how badly you are disabled by the disease.
Industrial Injuries Disablement Benefit cannot be paid for the first 15 weeks (90 days not including Sundays), after the date of onset of the disease. [Legislation (62)]
The exception to this is in claims for occupational deafness, when payment can only be made from the date the claim form is received in an office of the Department for Work and Pensions (DWP) , and in claims for diffuse mesothelioma and asbestos-related lung cancer, when payment can be made from the date you were first disabled by the disease but not for more than 3 months before the date of your claim. [Legislation (63)]
You will not normally get benefit if your disablement is less than 14%. [Legislation (64)]
But you may be able to get benefit if you have had more than one accident or disease and the total disablement, when the effects of all the accidents and diseases are added together, is 14% or more. This is known as aggregation.
If your disablement is at least 14% your benefit will be paid as a weekly pension. [Legislation (65)]
If your disablement is:
between 14% and 19% you will get a pension at the 20% rate
20% or over it will be rounded up or down to the nearest 10%. [Legislation (66)]
The following table provides a breakdown of the percentage assessment and percentage payable:
|Percentage assessment||Percentage payable|
|14 – 24 %||20%|
|25 – 34 %||30%|
|35 – 44 %||40%|
|45 – 54 %||50%|
|55 – 64 %||60%|
|65 – 74 %||70%|
|75 – 84 %||80%|
|85 – 94 %||90%|
|95 – 100%||100%|
The maximum rate payable for Industrial Injuries Disablement Benefit is 100% even if you have several assessments which add up to more than 100%.
For current rates see Benefit and pension rates (BRA5DWP)
Rules for specific diseases
Pneumoconiosis and byssinosis
For the respiratory diseases pneumoconiosis, byssinosis you can get benefit if your disablement is assessed as at least 1%. [Legislation (67)]
For the respiratory disease diffuse mesothelioma your disablement will be assessed as being 100% [Legislation (67)]
Asbestos-related lung cancer
For this respiratory disease your disablement will be assessed as being 100%.
To get benefit for occupational deafness, your disablement must be assessed as 20% or more. [Legislation (68)]
If the assessment is less than 20% for occupational deafness it cannot be aggregated with any other assessment of disablement. [Legislation (69)]
Chronic bronchitis and emphysema
If you claim for chronic bronchitis and emphysema you must not already be getting any benefit which takes full account of this condition.
For example, if you have been awarded Industrial Injuries Disablement Benefit for pneumoconiosis and your disablement from pneumoconiosis, or pneumoconiosis with tuberculosis, has been assessed at 50% or more you may have already had your benefit increased to take full account of bronchitis/emphysema.
If so you will not qualify separately for bronchitis/emphysema but if you think your bronchitis/emphysema has got worse, you should apply to have your assessment for pneumoconiosis looked at again in case it can be increased.
How you are paid
Our policy is to pay all benefits directly into an account.
This is the safest way to pay you and lets you choose how and when you get your money. You can use a bank or building society.
You may be able to use a cash machine, which will usually mean you can get your money at any time of the day or night.
There are arrangements with banks and building societies so that you can collect cash from some of their accounts at your Post Office® branch.
The other advantages of having your money paid into an account are:
- you can get your money from many different places
- from some accounts you could have regular bills paid. This could save you money but you will need to make sure that there is enough money in your account to pay the bills. If not, you may be charged a fee
- using an account may help you save.
The account can be:
- in your name, or
- in the name of your partner. We use partner to mean a person you are married to or a person you live with as if you were married to them, or a civil partner or a person you live with as if you are civil partners, or
- in the names of both yourself and your partner, or
- in the name of the person acting on your behalf, or
- in the names of both yourself and the person acting on your behalf.
Benefit is paid either every 4 weeks, every 13 weeks or every week.
If you have a bank or building society account but you do not wish to use it, for example a joint account, any bank or building society will help you open an account that suits you better. Remember to ask whether their accounts allow you to get your money from the Post Office®, if this is important to you.
Basic bank account
If you have had problems opening a current account, or if you are worried about being overdrawn, you could ask any bank or building society about opening a basic bank account.
These are sometimes called introductory or starter accounts and are available from all major banks.
These accounts offer free banking but overdrafts are not available.
You can use these accounts to pay money in, pay bills automatically and get cash out.
Many basic bank accounts also allow you to get cash from Post Offices®.
If your circumstances change
A decision can be looked at again at any time if your condition has changed.
If you feel your condition has got worse and you want us to have another look at the decision, complete and return form BI168, which you can get from your Regional Industrial Injuries Disablement Benefit Centre.
If the condition for which you are getting benefit improves you must tell us straight away.
If you are receiving Industrial Injuries Disablement Benefit you must also tell us if
- you marry, remarry, or form a civil partnership and change your name
- you change your address
- you leave the country
- you go into prison.
If any of these apply, you must tell your Regional Industrial Injuries Benefit Delivery Centre straight away. [Legislation (70)]
If you leave the country
If you leave the country, Industrial Injuries Disablement Benefit is payable while you are away. For further details please read the ‘How you are paid Industrial Injuries Disablement Benefit’ paragraphs of this guide.
If you intend to be away for more than 3 months, payment of your benefit will be made by the International Pensions Centre (IPC).
You will be asked how you want your payments to be made while you are away. You can choose between:
- Direct Payment to a United Kingdom (UK) bank, building society or Post Office® card account every 4 or 13 weeks
- payable orders sent directly to you every 4 or 13 weeks while you are away
- Transcontinental Automated Payments (TAPS), if the country has this arrangement with Jobcentre Plus
- payment to a nominee
- payment when you return to the UK.
You must let us know when you return to the UK.
If you go to prison
If you go into prison, you must let us know the date you were admitted.
Payment of Industrial Injuries Disablement Benefit is suspended during any period of imprisonment.
When you are released let us know the date. Arrears of Industrial Injuries Disablement Benefit may be paid for the period of imprisonment subject to a maximum of one year’s benefit.
If you die
If you die, someone should let us know straight away.
Effects of Industrial Injuries Disablement Benefit on other benefits
Your basic Industrial Injuries Disablement Benefit does not affect any other National Insurance (NI) benefits such as:
- Incapacity Benefit
- Employment and Support Allowance (contribution-based)
- Contribution-based Jobseeker’s Allowance
- Retirement Pension.
But Industrial Injuries Disablement Benefit may affect income-related benefits that you or your partner receive such as:
- Income Support
- Employment and Support Allowance (income-related)
- Income-based Jobseeker’s Allowance
- Pension Credit
- Housing Benefit
- Working Tax Credit
- Child Tax Credit
- Universal Credit.
Note: You will have to contact your local authority to confirm if any reduction you or your partner receive in your council tax bill is affected.
Industrial Injuries Disablement Benefit may also affect how much War Pension you get, if you are entitled to both.