Social Security
(Incapacity Benefits) (Jersey) Order 2004
Made 21st July 2004
Coming into force 1st
October 2004
THE EMPLOYMENT AND SOCIAL SECURITY COMMITTEE, in pursuance of Articles 14, 18,
29 and 51 of the Social
Security (Jersey) Law 1974,[1] orders as follows –
1 Interpretation
In this Order, unless the context otherwise requires –
“determining authority” means, as the case requires, the determining officer or the
Social Security Tribunal;
“Law”
means the Social Security (Jersey) Law 1974;[2]
“medical authority” means a medical appeal tribunal or a medical board, or a
medical practitioner nominated by the Committee;
“standard rate of benefit” means the standard rate of benefit at the commencement of a
specified period of incapacitation.
2 Days
that are not to be treated as days of incapacity for work
(1) For
the purpose of the provisions of the Law relating to short term incapacity
allowance, a day shall not be treated in relation to any person as a day of
incapacity for work if –
(a) it
is a day in respect of which the person fails to prove, in such manner as the
Committee may require, that he or she is incapable of work;
(b) it
is a day in respect of which he or she is disqualified for receiving short term
incapacity allowance; or
(c) it
is a day on which he or she does any work, whether or not it is work for which
remuneration is payable.
(2) Paragraph
(1) is subject to Articles 3 and 5.
3 Days
that are to be treated as days of incapacity for work
(1) This
Article applies to a person who, though not incapable of work, is excluded from
work on the certificate of the Medical Officer of Health and is under medical
observation –
(a) by
reason of the person’s being a carrier of infectious disease; or
(b) by
reason of his or her being having been in contact with a case of infectious
disease.
(2) For
the purpose of any provision of the Law relating to short term incapacity
allowance, a day shall be treated in relation to any person to whom this
Article applies as a day of incapacity for work, if he or she does no work for
which remuneration is payable or would ordinarily be payable.
(3) However,
the number of days that are to be treated under paragraph (2) as days of
incapacity for work shall not exceed 42 or such greater number as the Committee
in any particular case may allow.
(4) A
person in relation to whom a day would otherwise be a day of incapacity for
work because it is a day described in Article 2(1)(a) may nevertheless be
treated as being incapable, by reason of some specific disease or bodily or
mental disablement, of work on any day on which this Article applies to the
person.
4 Night
workers
(1) This
Article applies, in relation to night workers, for the purposes of short term
incapacity allowance.
(2) Where
a period of employment begins on one day and extends past midnight into the
following day, and the employment before midnight is of longer duration than
that after midnight –
(a) the
person employed shall, in respect of that period, be treated as having been
employed on the first day only; and
(b) the
first day shall not be treated as a day of incapacity for work.
(3) Where
a period of employment begins on one day and extends past midnight into the
following day, and either the employment after midnight is of longer duration
than that before midnight or the employment before and after midnight is of
equal duration –
(a) the
person employed shall, in respect of that period, be treated as having been
employed on the second day only; and
(b) the
second day shall not be treated as a day of incapacity for work.
(4) Where –
(a) a
person is, by virtue of paragraph (2) or paragraph (3), to be treated
as having been employed on one only of 2 days; and
(b) throughout
that part of the other day during which the person is not employed, he or she
is incapable of work,
the person shall, for the purposes of short term incapacity
allowance, be treated as being incapable of work throughout that other day.
(5) Where –
(a) a
person is, by virtue of paragraph (3), to be treated as having been
employed on the second only of 2 days; and
(b) throughout
the day immediately preceding the first of those 2 days, he or she is incapable
of work,
the person shall, for the purposes of short term incapacity
allowance, be treated as being incapable of work throughout the first of the
2 days to which that paragraph refers.
5 Delay
and failure to claim benefit
Notwithstanding Article 2, a person who would have been entitled
to an incapacity benefit for any day but for any delay or failure to make or
prosecute a claim shall be treated as having been entitled to benefit for that
day.
6 Obligations
of claimants and beneficiaries
(1) A
person who is a claimant for an incapacity benefit, or is a beneficiary in receipt
of such a benefit, shall comply with every direction in writing that is given
to the person by the Committee and requires him or her to submit for any
purpose specified in paragraph (2) to –
(a) a
medical examination by a medical authority; or
(b) any
other appropriate examination.
(2) The
purposes to which this paragraph refers are –
(a) the
determining of the effect of the illness or accident in respect of which that
benefit is claimed; or
(b) the
determining of the treatment that is appropriate to any relevant disease or
injury or any relevant loss of faculty.
(3) A
direction under paragraph (1) may require that the examination be
undertaken at any place specified in the direction (including the
claimant’s place of residence).
(4) A
person who is a claimant for an incapacity benefit, or is a beneficiary in receipt
of such a benefit, shall comply with every direction in writing that is given
to the person by the Committee and requires him or her to submit to such
medical treatment as –
(a) the
medical practitioner in charge of the case; or
(b) any
medical authority to whose examination the person has submitted in accordance
with paragraph (1),
considers appropriate in his or her case.
(5) A
direction under this Article shall not ordinarily require a person to submit to
examination by a medical board before the expiration of the period of 7 days
beginning with the date on which the direction is given, but it may require the
person to do so within a shorter period or immediately if in either case that
is reasonable in the particular circumstances.
(6) A
direction under this Article in any other case may require a person to be
examined at a time and place to be specified subsequently on 2 clear days’
written notice to the person, but shall not otherwise require him or her to
submit to examination before the expiration of 3 days beginning with the
date on which the direction is given.
(7) Every
claimant or beneficiary who in accordance with this Article is required to
submit to an examination or to treatment shall do so at every such place and
time as may be required.
7 Disqualification
for short term incapacity benefit
(1) A
person shall be disqualified for receiving a short term incapacity allowance
for a day of incapacity for work, a long term incapacity allowance or an
incapacity pension, if the relevant disease or injury is attributable to his or
her own wilful act.
(2) A
person may be disqualified for receiving a short term incapacity allowance for
a day of incapacity for work, a long term incapacity allowance or an incapacity
pension if –
(a) the
person behaves in a manner calculated to retard his or her recovery from the
relevant disease or injury;
(b) the
person fails without good cause to furnish to the Committee any information
required for the determination of his or her claim or of any question arising
in connection with the matter;
(c) the
person fails without good cause to comply with a direction given to him or her
in accordance with Article 6, or with any requirement under paragraph (5)
of that Article, in respect of the relevant disease, injury or loss of faculty;
or
(d) the
person wilfully obstructs or is guilty of any other misconduct in connection
with any examination or treatment to which he or she is directed under Article 6
to submit.
(3) However,
no person shall be disqualified under this Article –
(a) for
a period exceeding 13 weeks; or
(b) for
refusing to undergo a surgical operation that is not of a minor character.
(4) A
person who would be entitled to incapacity benefit but for any other provision
of this Article shall nevertheless be treated as if he or she were entitled to
that benefit for the purposes specified in paragraph (5).
(5) The
purposes to which this paragraph refers are those of any rights or obligations
under the Law that for their part depend on his or her being entitled to the incapacity
benefit (other than the right to payment of that benefit itself).
(6) It
is immaterial whether the other rights and allowances are those of that person
or of another person.
8 Entitlement
to lump sum
(1) A
person –
(a) who
is entitled to long term incapacity allowance or an incapacity pension; and
(b) whose
specified degree of incapacitation resulting from his or her loss of faculty is
not less than 5 per cent and not more than 15 per cent,
shall be entitled to a lump sum payment calculated in accordance
with this Article.
(2) Where
the period of incapacitation specified in an assessment of a person to whom paragraph (1)
applies is 7 or more years, he or she shall be entitled to a lump sum equal to
the same percentage of the standard rate of benefit as the percentage of his or
her degree of incapacitation, multiplied by 364.
(3) Where
the period of incapacitation specified in an assessment of a person to whom paragraph (1)
applies is less than 7 years, he or she shall be entitled to a lump sum
equal to the same percentage of the standard rate of benefit as the percentage
of his or her degree of incapacitation, multiplied by the number of weeks in
the specified period of incapacitation.
(4) Where
the period of incapacitation specified in an assessment of a person to whom paragraph (1)
applies is that person’s life, he or she shall be entitled to a lump sum
equal to the same percentage of the standard rate of benefit as the percentage
of his or her degree of incapacitation, multiplied by –
(a) 416,
if he or she has attained the age of 55 but is not yet 65;
(b) 468,
if he or she has attained the age of 45 but is not yet 55;
(c) 520,
if he or she has attained the age of 35 but is not yet 45;
(d) 572,
if he or she has attained the age of 25 but is not yet 35; or
(e) 624,
if he or she has not yet attained the age of 25.
9 Partial
satisfaction of contribution conditions
(1) This
Article applies where a person would be entitled to an incapacity benefit but
for the fact that the relevant contribution conditions set out in paragraph 1(1)(b),
paragraph 2(1)(b) or paragraph 3(1)(b) respectively of the Second Schedule to
the Law[3] are not satisfied.
(2) The
person shall nevertheless be entitled to that benefit at a reduced rate
ascertained in accordance with paragraph (3) or paragraph (4), as the
case requires, if the contribution factor derived from contributions paid by or
credited to that person in respect of the relevant quarter is not less than 0.33.
(3) The
weekly rate of short term incapacity allowance or incapacity pension payable in
respect of a person by virtue of paragraph (2) shall be the same
proportion of the appropriate weekly rate of benefit set out –
(a) in the
second column of Part I of the First Schedule to the Law;[4] and
(b) where
applicable, in Part III of the First Schedule to the Law,[5]
as the contribution factor derived from contributions paid by or
credited to that person in respect of the relevant quarter is of a contribution
factor of 1.00.
(4) The
weekly rate of long term incapacity allowance payable in respect of a person by
virtue of paragraph (2) shall be the same proportion of the percentage of
his or her degree of incapacitation as the contribution factor derived from
contributions paid by or credited to that person in respect of the relevant
quarter is of a contribution factor of 1.00.
10 Revocations
The following Orders shall be revoked –
(a) the
Social Security (Incapacity Benefit)
(Jersey) Order 1974;[6]
(b) the
Social Security (Accident Benefit) (Jersey)
Order 1974;[7]
(c) the
Social Security (Incapacity Benefit)
(Amendment) (Jersey) Order 1982;[8]
(d) the
Social Security (Incapacity Benefit)
(Amendment No. 2) (Jersey) Order 1983;[9]
(e) the
Social Security (Payment for Sundays)
(Jersey) Order 1986;[10]
(f) the
Social Security (Incapacity Benefit)
(Amendment No. 3) (Jersey) Order 1989.[11]
11 Citation
and commencement
This Order may be cited as the Social Security (Incapacity Benefits)
(Jersey) Order 2004 and shall come into force on 1st October 2004.
M.N. DE LA HAYE
Greffier of the States.