Social Security
(Assessment of Long Term Incapacity) (Jersey) Order 2004
1 Interpretation
In
this Order, “Law” means the Social Security (Jersey) Law 1974.
2 Principles
of assessment
(1) The extent of a
claimant’s incapacitation shall be assessed, by reference to the loss of
faculty incurred by the claimant as a result of the relevant disease or injury,
in accordance with the following general principles –
(a) the
incapacitation to be taken into account shall be the whole of the loss of
faculty to which, having regard to the claimant’s physical and mental
condition at the date of the assessment, the claimant may be expected to be
subject during the period taken into account by the assessment as compared with
a person of the same age and sex whose physical and mental condition is normal;
(b) the
question whether or not any incapacitation involves inability to work, loss of
earning power or additional expense shall be immaterial;
(c) the
percentage of the degree of incapacitation incurred (whether as the result of
one or more claims) shall not be taken to amount in the aggregate to more than
100%;
(d) incapacitation
shall not be so treated as resulting from a relevant disease or injury in so
far as the claimant would in any case have been subject to that incapacitation
as the result of a congenital defect or of a disease or injury contracted or
received before the relevant disease or injury;
(e) incapacitation
shall not be so treated as resulting from a relevant disease or injury in so
far as the claimant would not have been subject to that incapacitation but for
some disease or injury that is contracted or received after the relevant
disease or injury and is not directly attributable to the relevant disease or
injury;
(f) the
assessment shall be made without reference to any of the particular circumstances
of the claimant except that person’s age, sex, and physical and mental
condition.[2]
(2) The general principles
in sub-paragraphs (d) and (e) of paragraph (1) are subject to Article 5.
(3) For the purposes of
paragraph (1)(a), the period to be taken into account, in respect of each
claim, by an assessment shall begin on –
(a) the
date on which there ended the last period for which the claimant was assessed
as being entitled to long term incapacity allowance; or
(b) if
the claimant has not previously been so assessed –
(i) the date of his
or her claim, or
(ii) if
applicable, and earlier than the date of his or her claim, the date on which
the claimant ceased under Article 15(2) of the Law to be entitled to short
term incapacity allowance,
but in any event that period shall not begin before the date which
is 3 months earlier than the date of the claim in respect of which the
assessment is made, except in a case falling within Article 13(3) of the Social Security (Claims and Payments) (Jersey)
Order 1974.[3]
3 Losses
of faculty described in the Schedule
(1) This Article applies
where, as a result of the relevant disease or injury, the claimant has suffered
a loss of faculty specified in the first column of the Schedule.
(2) Subject to paragraphs (3)
and (5), the loss of faculty suffered by the claimant as a result of that
disease or injury shall be treated for the purposes of Article 16 of the
Law as resulting in the degree of incapacitation in the second column of the
Schedule in respect of that disease or injury.[4]
(3) Where either of the
circumstances in paragraph (4) applies, the assessment of the degree of
incapacitation suffered by the claimant shall be subject to such adjustment as
is reasonable in the circumstances of the case.[5]
(4) The circumstances to
which this paragraph refers are –
(a) that
as a result of the relevant disease or injury, and having regard to his or her
physical and mental condition at the date of the assessment, the claimant may
be expected to be subject to a greater degree of incapacitation than would
normally be incurred as a result of such a disease or injury; or
(b) that
apart from the relevant disease or injury, the part of the claimant’s
body that is affected by the disease or injury would not have been normal at
the date of the assessment.
(5) Where a medical board
is required to assess a period of incapacitation prior to the date of the
assessment, the degree of incapacitation suffered by the claimant shall be
subject to such adjustment as is reasonable in the circumstances of the case.[6]
(6) An adjustment, under
paragraph (3) or (5), of an assessment of the degree of
incapacitation –
(a) may
specify different percentage degrees for different periods; and
(b) may specify
percentage degrees which are not specified in the second column of the
Schedule.[7]
4 Losses
of faculty not described in the Schedule
For the purpose of assessing the extent of the incapacitation
resulting from any disease or injury that is not specified in the Schedule, a
medical board or a medical appeal tribunal may have such regard as is
appropriate to the provisions of Article 3.
5 Interchangeable
or complementary organs
(1) This Article applies
where a claimant has suffered a relevant disease of or injury to an organ of
his or her body that, in a person whose physical condition is normal, would be
one of 2 similar organs whose functions are interchangeable or complementary
(for example, the kidneys).
(2) Paragraphs (3) and
(4) shall apply in assessing the extent of the incapacitation resulting from
the relevant loss of faculty for any period during which the claimant may be
expected to be subject to any incapacitation resulting from the relevant
disease or injury.
(3) Any incapacitation in
respect of the other organ to which the claimant would in any case have been
subject by reason of a congenital defect, or a disease or injury
that –
(a) is
contracted or received before the relevant disease or injury; and
(b) is
not attributable to any other disease or injury,
shall be treated as having been incurred as a result of the relevant
disease or injury.
(4) Any incapacitation in
respect of the other organ to which the claimant would not have been subject
but for some disease or injury that –
(a) is contracted
or received after the relevant disease or injury; and
(b) is
not attributable to any other disease or injury,
shall also be treated as having been incurred as a result of the
relevant disease or injury.
(5) However, the degree of
incapacitation that shall be treated by reason of paragraph (3) as
resulting from a relevant disease or injury shall be that appropriate to
one-half of the percentage at which the extent of incapacitation resulting from
the relevant disease or injury would otherwise be assessed under this Order.
(6) Paragraph (4)
shall not in any event have effect unless the assessment in respect of the
relevant loss of faculty would be thereby increased.
6 Citation
This Order may be cited as the Social Security (Assessment of Long
Term Incapacity) (Jersey) Order 2004.