Social Security
(Incapacity Benefits) (Jersey) Order 2004[1]
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;
“medical authority” means a medical appeal tribunal or a
medical board, or a medical practitioner nominated by the Minister;
“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
Minister 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, 3A and 5.[2]
3 Days
that are to be treated as days of incapacity for work: infectious disease[3]
(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 Minister 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.
3A Days that are to be
treated as days of incapacity for work: phased return to work[4]
(1) This
Article applies to a person who undertakes activity during a week, including
work, that has been agreed with a determining officer as part of a plan to
assist the person’s return to work (a “return to work plan”).
(2) Where
this Article applies, the person is treated as incapable of work for any day in
that week on which the person undertakes activity permitted by the return to
work plan.
(3) The
return to work plan –
(a) may include
any activity that the determining officer considers would assist the person in
returning to work, including work (whether paid or unpaid) and training; and
(b) must
not exceed a total of 8 weeks (whether or not consecutive) in a period of
incapacity except in cases where the determining officer considers that further
activity is appropriate to assist the person’s return to work.
(4) This
Article does not apply to any day on which a person undertakes activity that
exceeds the activity permitted by the return to work plan for that week, and
that day is not treated as a day of incapacity for work.
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 Minister 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 Minister 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 Minister 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 of pensionable age;
(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.[5]
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 Schedule 2 to the
Law 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 1 of Schedule 1 to the Law; and
(b) where
applicable, in Part 3 of Schedule 1 to the Law,
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 Citation
This Order may be cited as the Social Security (Incapacity Benefits)
(Jersey) Order 2004.