Determining whether you are Eligible for Incapacity Benefit

Incapacity Benefit (IB) is a contributions-based benefit for people who are unable to work due to sickness. In 2008, the UK government started the new Employment Support Allowance (ESA) which rolls IB and other benefits into one. Although Incapacity Benefit does still exist in its own right for previous claimants, any new claims will be dealt with under the new title. However, this is mostly a name change in order to simplify matters: the eligibility requirements remain pretty much the same.

Eligibility for IB is determined by a few very basic factors, despite the fact that – especially in unusual circumstances – it is a complex decision process. Firstly, claimants must be over the age of 16 and under pension age (generally 60) when they begin being ill. There is also an IB for young people, but that’s a separate and also complicated process: this article will deal with adult IB.

Secondly, claimants must be ill and have been unable to work for four consecutive days. British companies allow a minimum of three days of self-certification for illness, so IB kicks in after that initial period. If a person was claiming JobSeeker’s Allowance (i.e. they were unemployed), they still receive their three days of JSA then switch to IB, the same as if they were working.

Proving you are ill is the most important factor in determining your eligibility. Getting a medical certificate from your doctor is absolutely vital to a claim for IB, as without one it is extremely unlikely your claim will be processed. You’ll need to present the certificate when you go in to the Job Centre, so make sure you keep it safe. Also, make sure it covers every single day of sickness and that you get a new certificate when the old one runs out – any gaps will not be paid and a prolonged period without a certificate will result in your claim being closed.

If you’ve been working and your employer is paying you Statutory Sick Pay (SSP), you will not be eligible for IB until the period of SSP ends. The basic rates are the same anyway, so the former negates the latter.

The most complicated eligibility requirement is based on National insurance contributions. To receive IB, a person must have enough contributions: that is, they’ve paid into the ‘public pot’ out of their earnings and so earn the right to get something back. Most people don’t know if they’ve made enough payments, so the best advice is to claim anyway. It does not matter if claimants were employed or self-employed: the rule is the same in all cases.

In the case where the contributions are too low, a claimant will receive ‘credits’ to continue accruing National Insurance, but will not get any money. However, don’t fret: Income Support (IS) and IB work hand in hand, so people who only get credits from IB are frequently eligible to payments of IS instead.

If you’re ill for quite a while, IB also rises. After the first 28 weeks (six months or so), people move from the short term lower rate to a higher rate. After the first year, they move onto the long term rate. These dates are calculated from when you became ill, so a period of SSP does count towards the total number of weeks.

Because IB is a replacement for earnings and is not based on means-tested methodologies, any money you earn or have as savings (above a certain amount) will count against the benefit you receive. It is also possible to work while receiving IB, but this has to be agreed by the Job Centre. They call it ‘permitted work’ and the earnings still affect the amount of IB you receive. If you want to try this, discuss it with a member of staff at the Job Centre first.

One last note harks back to the earlier mention of Income Support. IB and IS work together to ensure that people have enough money (in the government’s opinion) to live. Eligibility for IS is based on separate criteria and it has many ‘premiums’ which can affect how much money a person is allocated (e.g. carer’s premium or disability premiums). Consequently, if you are claiming IB, always claim IS at the same time: you may receive top-up payments from the latter.

Full details of Incapacity Benefit can be found on the DirectGov site.