Last Updated on Thursday, 17 October 2013 10:46
SECTION 13: NHS INJURY BENEFITS SCHEME
13.1 Changes to the NHS Injury Benefits Scheme 31 March 2013
Temporary and Permanent Injury Benefit payable under the NHS Injury Benefit Scheme will no longer be available to employees who sustain an injury or contract a disease due to NHS employment on or after 31 March 2013.
From 31 March 2013 Temporary Injury Benefit will be replaced by a new allowance known as Injury Allowance and will form part of NHS Staff Terms and Conditions of Service set out in section 22. Permanent Injury Benefit under the NHS Injury Benefit Scheme will no longer be available to employees who sustain an injury or contract a disease due to NHS employment on or after 31 March 2013.
The new Injury Allowance (IA) covers employees who sustain an injury or contract a disease or other health condition due to NHS employment on or after 31 March 2013.
Employers are responsible for the administration and payment of the IA. The criteria for awarding IA and the level of that allowance are similar to the Temporary Injury Benefit payable under existing NHS Injury Benefit provisions. However, the new IA is limited to the period of the employment contract and a maximum payment period of 12 months for each relevant injury or disease.
Any dispute regarding entitlement to IA falls to be considered under employer's local grievance procedures.
SPPA will process Injury Benefit applications received by 30 March 2018 only, for an injury or disease occurring on or before 30 March 2013.
SPPA will process Injury Benefit applications received by 30 March 2038 only, for applicants who can provide evidence there has been a delayed onset of their symptoms, such that an application was not previously necessary before 30 March 2018.
Access to the NHS Injury Benefit Scheme closes on 31 March 2038.
No new applications will be accepted by SPPA on or after this date.
SPPAs NHS Injury Benefit Team can be contacted direct if there are any questions regarding the scheme or issues with a specific application.
13.3 Overview of NHS Scotland Injury Benefits (for injury or disease occurring on or before 30 March 2013)
The NHS Injury Benefits Scheme covers most NHS employees, including General Practitioners and Dental Practitioners. The main exceptions being GP Practice staff and the majority of employees with Direction Body status. The governing regulations are not part of the National Health Service Superannuation Scheme (Scotland) (NHSSS(S)) and eligibility to claim Injury Benefit does not rely on superannuation scheme membership. However, any pension paid from the NHSSS(S) is taken into account when calculating an Injury Benefit.
The NHS Injury Benefit Scheme is a 'no blame' income protection scheme, which provides income protection for employees who suffer a loss of earnings, as a result of an injury, disease or condition that is wholly or mainly attributable to the duties of their NHS employment. No benefits would be payable if the injury or disease was seriously aggravated by the employee's own culpable negligence or misconduct.
If a claim is accepted, the employee may receive payment if:
- they are temporarily absent from work (usually certified sick leave) on reduced or no pay. A Temporary Injury Benefit (TIB) makes up their total reckonable income (which includes certain Department of Work & Pensions (DWP) benefits) to 85% of their average pay prior to reduced pay. Payment of TIB does not automatically lead to payment of Permanent Injury Benefit (PIB) and if/when the employee returns to work on full pay, TIB will stop. Until SPPA are advised of the employees return to work, TIB will continue to be considered, however, it is a temporary benefit.
- their permanent degree of earning ability is reduced in the general field of employment by more than 10% following termination of employment or re-employment at a lower income, due to the injury. All PIB applications are sent to our independent medical adviser for advice on acceptance and banding. If accepted the amount payable is variable and divided into five bands dependant on the degree of permanent loss of earning ability and length of NHS employment, PIB is payable for life.
- they die as a result of the injury or disease, leaving a spouse and/or dependants.
When calculating any Injury Benefit, other sources of income are taken into account. These include NHSSS(S) pension, further NHS earnings, certain personal pensions and any relevant DWP benefits.
Once TIB is awarded it is paid until the employee returns to work, is re-employed or employment is terminated. TIB can also be paid if an employee is on reduced pay whilst on a phased return to work. All benefits paid under the NHS Injury Scheme are index linked and payments made by our payroll are recharged to the relevant employer.
Up to 6 April 2011, SPPA calculated and paid all approved TIB in house after deducting tax. Instructions from HMRC, which took effect from 6 April 2011, mean that the payment of TIB or PIB to employees continuing in employment can be regarded as earnings from employment and National Insurance Contributions (NIC) must be deducted from payments. SPPA is, however, unable to deduct NIC, therefore, payment of effected benefits is passed to the relevant NHS employer payroll to pay and make the required deductions for tax and NIC.
The administration and calculation of NHS Injury Benefit remains with us. Any payments payable pre 6 April 2011 will continue to be paid by our Payroll and recharged accordingly.
Re-employment is similar to that for retired NHS scheme members in receipt of a pension. If the combined re-employment earnings plus PIB exceed the pre-retirement earnings then the PIB is reduced accordingly. Re-employed earnings for Injury Benefit abatement purposes also include any NHSSS(S) pension in payment. The Injury Benefit will be abated before the NHSSS(S) pension.
A damages or compensation award made in respect of the same injury may affect the applicant's Injury Benefit and some or all of the money paid under the Injury Benefit Scheme may have to be recovered or offset against future benefits. If an employee claims damages the employer's legal advisers should be made aware of the injury benefit application. When a claim for damages is settled, it is essential the employer notifies us immediately. Regulation 17 gives SPPA authority to withhold or reduce Injury Benefits, or in some cases, request repayment of all or some of the benefits already paid if the applicant received damages/compensation at a later date.
A booklet which provides more information and guidance to the Injury Benefits Scheme is available from our website www.sppa.gov.uk.
Anyone wishing to apply for NHS Injury Benefit should complete pages 1 and 2 of the INJ 1 application form. The completed form should be forwarded to the employer with the following information:
- witness statements and/or witness contact details, if no incident form completed
- copies of any relevant DWP benefit awarding letters
- any other relevant information.
On receipt of the application SPPA may require further medical information* from the employee's GP or consultant.
*Please note the applicant is responsible for the payment of any fees requested for the provision of such information.
SPPA require the employer to supply the following information in support of an application:
- an accident/incident report form
- all relevant reports held by Occupational Health, including details on any pre-existing and or related conditions
- applicant's job description
- any other relevant information.
In order to prevent any unnecessary delays and to avoid causing the applicant possible hardship, in addition to the completed INJ 1 form it is important the above information is provided. It is advisable that all injury applications and supporting information should be sent by Recorded Delivery for the attention of the NHS Injury Benefits Team.
All sections in the employer part of the INJ 1 form must be completed in full. Contact names and telephone numbers are essential. The requested information must be provided where possible and all relevant sections of form complete. If for any reason the employer is unable to do so, a written statement to verify this must be supplied.
The employer payroll department must complete parts 2 and 3. Pay figures should be provided in the requested format and our Injury Benefit Team must be informed of any changes in the pay or dates as soon as possible. We will advise NHS payroll of an applicant's acceptance and for TIB, monthly pay figures should be provided on a regular basis to avoid late or non payment to the applicant. These pay figures should cover the period that the applicant goes on to reduced pay until the day the applicant returns to their post and contracted hours or their contract is terminated.
Any loss of earnings incurred during a phased return to work must also be submitted to our Injury Benefit Team, with a letter from the Human Resources or Occupational Health department supporting the employee's phased return.
Any medical or private documents sent in with the completed application form should be in a sealed envelope clearly marked with the applicant's name, superannuation scheme reference number (if applicable) and National Insurance number.
Incomplete application forms will not be processed and will be returned to the employer for completion and the applicant advised accordingly.
The NHS Injury Benefit Team can be contacted direct if there are any questions regarding the scheme or issues with a specific application.