The payments formerly known as disability and sickness benefit are now known as illness benefit. Illness benefit is payable to a person under 66 for days missed from employment, due to incapacity. Certain conditions apply. A day of incapacity is a day in which the person is incapable of work. The benefit is not payable for the first three days. Neither Sunday, nor holidays count for such purposes.
The person must show he is incapable of work on the day concerned. If he actually works and does work other than rehabilitative work, he does not qualify. Any three days within six consecutive days are treated as periods of incapacity. Periods separated by less then four days are treated as a single period. Therefore, if a person for example is incapable of working for three days returns to work on the fourth day, but is incapable again in the fifth day, the fifth day will be treated as qualifying, without a further three day wait.
A person must be incapable of work by reason of a disease, bodily, or mental, disablement, or impairment in accordance with regulations. The illness must be certified by a doctor, generally.
Where a claimant is unable to follow his usual occupation but could be fit for a less demanding form of work, he may be regarded as incapable, if it is likely that he will soon be able to return to his former occupation. In the longer term, the person certifying illness must consider if the physical or mental condition of the claimant is such that he is capable of performing alternative work, which he could reasonably be expected to undertake after taking into account his training, educational experience and age.
A person may be deemed incapable of work if although not in fact incapable, he cannot go to work such for example, where he is under medical care for a disease or disablement and the medical doctor certifies that he should not work or is an probable source of infection.
A person may be incapable of his normal own employment but be capable of another form of employment. However, if he is likely to return to his occupation this will be treated as a period in which he is incapable of work. If, however, the person is capable of performing different work in longer term he would be deemed capable and it would not be appropriate that he be certified as incapable.
A person may be deemed incapable of work on account of being certified as being recovering from a disease or disablement, or a possible source of infection and where he abstains from work on the order or advice of a doctor.
Any three days of interruption of employment, whether by way of unemployment or incapacity is deemed an interruption of employment, if they occur within a period of six days. Any periods not separated by more than 13 weeks are deemed a single period of interruption of employment. A day on which a woman is entitled to and in receipt of maternity benefit is treated as a day of incapacity for the purpose of computing interruption of employment
In order to qualify for injury benefit the person must have
- 104 weeks’ contributions since first employment:
- 39 paid or credited contributions in the second last year before the claim or,
- 26 paid in each of the second and third last contribution years.
Illness benefit is at a fixed rate with increments for children and qualified dependent adults.
A person must have reckonable weekly earnings in excess of a certain amount in the contribution year concerned. The current amount is €300. Reduced rates of benefit applied between €32 and €300.
A person satisfying the conditions may qualify for illness benefit for up to a year. Two periods separated by less than one year count as one. After that a person must re-qualify.
Prior to 2009 a person who had five years contribution could potentially continue to receive illness benefit up to retirement age. A person may qualify for up to two years without re-qualifying under the new rule.
A person is disqualified from illness benefits if he
- is incapable of work due to his own misconduct:
- fails without good cause to comply with requirements specified
- including medical attendance and examination or comply with instructions issued by a doctor, refraining from a behavior likely to hinder recovery or
- is not available to meet with an officer of the department
A person may continue to receive illness benefit while engaging in certain types of employment or training as may be prescribed by regulations. The prior consent of the Department of Social Protection is required. Consent may be granted for work or training, if a person has become incapable of following his normal occupation and is undergoing a course of training with a view to taking another occupation, or is engaged in parttime work of an rehabilitative or occupational therapy nature .
A person may undertake
- light work, without permission, where no remuneration is or normally would be payable:
- work undertaken as part of treatment while the patient is in the hospital where earnings do not exceed €50;
- work under a scheme that this charitable in character and the earnings do not exceed €50.
A person will not qualify for illness benefit, if he or she is out of the State, subject to certain exceptions or in prison. European Union Rights may alter the position in a particular case.
The personal rate is dependent on prior weekly earnings to some extent. There must be reckonable weekly earnings in excess of €300 for the previous contribution year. A person who has reckonable earnings less than €32 a week is deemed to have reckonable earnings of €32 per week. The person must have reckonable weekly earnings in excess of the prescribed amount, €300 per week.
The reckonable earnings for the relevant year are divided by the number of contributions paid. Persons with reckonable earnings below €32 are deemed to have reckonable earnings of €32. Between €32 and €300, there is a reduced rate of benefit applicable. In order to requalify, a person must have 13 paid contributions, since the last day for which he was entitled to the benefit and also satisfy the contribution conditions.
The 2020 Act reduced from 6 days to 3 days, the number of “waiting” days before which a claimant qualifies for Illness Benefit. Under these provisions, a claimant is entitled to Illness Benefit from the fourth day of illness. Illness Benefit is a payment made to insured people who are unable to work due to illness and who satisfy certain PRSI contribution conditions.