Injury & Disablement
Occupational Injuries
The Occupational Injuries Scheme provides benefits for people injured or incapacitated by an accident at work or while travelling directly to or from work. The scheme also covers people who have contracted a disease as a result of the type of work they do. There are a number of benefits available and there are different conditions attached to each benefit.
The benefits are:
- Injury Benefit
- Disablement Benefit
- Incapacity Supplement
- Constant Attendance Allowance
- Medical Care Scheme.
There are also death benefits under this scheme:
- Widow’s, Widower’s or Surviving Civil Partner’s Pension (paid at a higher rate than the ordinary Contributory Widow’s, Widower’s or Surviving Civil Partner’s Pension)
- Orphan’s Pension
- Funeral Grant
Injury Benefit
Injury Benefit is a weekly payment if the claimant is unfit for work due to the accident or disease. Payment is normally made from the 4th day of incapacity for work.
Injury Benefit can be paid for up to 26 weeks from the date of the accident or development of the disease . If the accident or disease caused loss of physical or mental ability, the claimant ma apply for Disablement Benefit before Injury Benefit ceases. If he or she is still unfit for work after 26 weeks he or she may apply for Illness Benefit or Disability Allowance.
Disablement Benefit
Disablement Benefit is paid if there has been a loss of physical or mental faculty after the accident or disease. It is not required that the person is unfit for work.
There must be a medical assessment to determine the degree of loss of faculty and the rate of benefit is based on this. Disablement Benefit can be paid as a lump sum (called Disablement Gratuity) or as a weekly payment (called Disablement Pension).
Incapacity Supplement
Incapacity Supplement is a weekly supplement, which may be paid if the claimant is not eligible for Illness Benefit or another social welfare payment. To get the supplement they must be getting Disablement Pension and be permanently incapable of work.
Constant Attendance Allowance is a weekly allowance, which may be paid to a claimant in receipt of Disablement Benefit who is seriously disabled as to need someone to help you daily at home to attend to personal needs.
Medical Costs
Medical costs incurred as a result of an occupational injury or disease, and of certain expenses which are not covered by the Health Service Executive (HSE) or through the Treatment Benefit Scheme under the Medical Care Scheme. The cost of private or semi-private accommodation and treatment cannot be recouped under the Occupational Injuries Scheme.
Qualification
In general people in employment insurable at PRSI Class A, D, J or M (Class M only where the employee is under 16 years of age) are covered in full for Occupational Injuries Benefits.
Civil servants recruited prior to April 1995 and insured at Class B may only qualify for limited Occupational Injuries Benefits. Education and Training Board trainees, people on employment schemes and people over 66 who are working are covered for Occupational Injuries Benefits.
Unlike other social insurance benefits, it is not necessary to have a set number of PRSI contributions to qualify. It is simply necessary to be in employment that is insurable for Occupational Injuries.
Personal Injury Claims
The Recovery of Certain Benefits and Assistance (RBA) Scheme enables the Department of Social Protection to recover the value of certain illness-related social welfare payments as a consequence of personal injuries claims. They are recovered from the compensator and not from the injured person.
Interaction with Statutory Sick Pay
Social Welfare (Miscellaneous Provisions) Act 2023 makes amendments to the Sick Leave Act 2022 and the Social Welfare Consolidation Act 2005. The main purpose of these amendments is to ensure that illness benefit, and injury benefit are not paid on days for which statutory sick pay is paid by a person’s employer, and to make arrangements for payment of statutory sick pay where an absence spans the end of a year.
Social Welfare (Miscellaneous Provisions) Act 2023 amends the Sick Leave Act 2022 to avoid a scenario whereby an employee who is in receipt of statutory sick pay, illness benefit or occupational injury benefit at the end of one calendar year would receive a statutory sick leave payment at the commencement of the next calendar year for the same instance of sick leave without having returned to work.
This will remove the risk of an employee, whose episode of illness crosses two calendar years, having their illness benefit or injury benefit claim interrupted by a period of statutory sick leave. It would also mean that a person would not be able to avail of two separate periods of statutory sick leave for a single absence from work due to illness that spans the year end.
Social Welfare (Miscellaneous Provisions) Act 2023 provides that a customer who has an entitlement to statutory sick pay from their employer (or a payment from their employer under a more favourable scheme) cannot have a concurrent entitlement to illness benefit.
It also provides that a person can only receive a maximum of 6 days payment in any week where payment is comprised by a combination of illness benefit and statutory sick pay. This is to ensure that employees who are entitled to statutory sick pay on a Sunday do not end up receiving payment totalling seven days, which would be more advantageous than for employees who do not work on a Sunday. In the case of the latter, these workers on a more typical weekday pattern would only qualify for a total of six days payment.
Occupational injuries benefits
Social Welfare (Miscellaneous Provisions) Act 2023 mirrors the illness benefit provision regarding injury benefit. A customer who has an entitlement to statutory sick pay from their employer (or a payment from their employer under a more favourable scheme) cannot have a concurrent entitlement to injury benefit.
A person can only receive a maximum of six days payment in any week where payment is comprised of a combination of injury benefit and statutory sick pay. This is to ensure that employees who are entitled to statutory sick pay on a Sunday do not end up receiving payment totalling seven days, which would be more advantageous than for employees who do not work on a Sunday. In the case of the latter, these workers on a more typical weekday pattern would only qualify for a total of six days payment.