Illness Benefits
Illness Benefit
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 Sundays 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 of Interruption
Periods separated by less than 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.
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.
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.
Incapable of Work
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.
Qualification
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.
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.
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.
Statutory Sick Pay
From 1 Jan 2024, Statutory Sick Pay (SSP) increased from 3 to 5 days a year. A person cannot qualify for Illness Benefit on the days that they receive SSP.
If the first illness in 2024 is less than 5 days and the person qualifies for Statutory Sick Pay, they don’t need to apply for Illness Benefit. For illnesses lasting more than 5 days, Illness Benefit starts from day 6.
If a person uses their 5 days of SSP in 2024 and becomes ill again in the same year, they receive Illness Benefit from day 4 of their illness, is after the normal 3 waiting days.
Benefit
Illness benefit is at a fixed rate with increments for children and qualified dependent adults. The personal rate is dependent on prior weekly earnings to some extent. The rates for 2024 are
Average weekly earnings | Personal rate | Increase for an adult dependant |
€300 or more | €232.00 | €154.00 |
€220 – €299.99 | €181.70 | €99.70 |
€150 – €219.99 | €149.60 | €99.70 |
Less than €150 | €104.10 | €99.70 |
Disqualification
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
Some Limited Work
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.
Duration
Illness Benefit is paid for a maximum of:
- 2 years (624 payment days) if there is at least 260 weeks of social insurance contributions paid since commencement of work or
- 1 year (312 payment days) if there is between 104 and 259 weeks of social insurance contributions paid since commencement of work.
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.
Illness benefit
Social Welfare (Miscellaneous Provisions) Act 2023 allows customers with a reduced PRSI contribution record to be paid illness benefit for a reduced period of 312 claim paid days (including days in receipt of statutory sick pay).
Social Welfare (Miscellaneous Provisions) Act 2023 amends illness benefit provisions in section 44 of the Social Welfare Consolidation Act 2005. Before 5 January 2009 there was no limit on the amount of time for which illness benefit could be paid to people who had more than 260 social insurance contributions. In Budget 2009 the Government decided to confine entitlement to illness benefit to two years (or 624 days) duration for claims arising after 5 January 2009. Persons in receipt of illness benefit on a continuous duration basis prior to 5 January 2009 were not affected by the change.
Social Welfare (Miscellaneous Provisions) Act 2023 amends the legislation to ensure that these various provisions in relation to duration of payment reflect the position that a person 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.
Social Welfare (Miscellaneous Provisions) Act 2023 provides that the definition of ‘injury benefit period’ remains 312 days but is now comprised of a combination of statutory sick pay from their employer and Illness Benefit.
66-70 Years
Social Welfare (Miscellaneous Provisions) Act 2023 amends provisions which relate to eligibility for illness benefit, to extend entitlement to the illness benefit scheme to those aged between age 66 and 70, born after 1 January 1958, who have not claimed State pension (contributory), provided the other conditionalities of the illness benefit scheme are met.
Social Welfare (Miscellaneous Provisions) Act 2023 provides that if a person is on illness benefit immediately before they turn 66, they must apply for remaining payments on foot of that existing claim to continue past 66.
Social Welfare (Miscellaneous Provisions) Act 2023 amends provisions which relate to eligibility for partial capacity benefit to provide entitlement to partial capacity benefit to a person born after 1st January 1958, if he or she has not claimed State pension (contributory) between the ages of 66 and 70, so long as the other requirements of partial capacity benefit are met.
Social Welfare (Miscellaneous Provisions) Act 2023 amends provisions to provide that, similar to illness benefit, if a person on partial capacity benefit is approaching their 66th birthday, they must apply for remaining payments on foot of that existing claim to continue past 66 provided they progressed to partial capacity benefit from illness benefit.