Incapacity Benefit

Incapacity Benefit has been abolished and replaced by Contributory Employment and Support Allowance. Incapacity Benefit was a benefit paid to people who either stop work or stop looking for work due to illness or disability.

It is a contributory-based benefit, which means you must have paid enough National Insurance contributions in one of the previous three financial years to qualify for it. These rules are different, however, for people under the age of 25: if you are under this age you can claim Incapacity Benefit in Youth without having paid the required National Insurance contributions in some circumstances. If you are over 25 and have not paid enough National Insurance contributions it is possible you can claim Income Support instead.  Incapacity Benefit is not affected by any savings you have and can be claimed even if you have a partner who is working.

How much is it?

From April 2010, Incapacity Benefit is paid at the following three rates:

• Short-term lower (paid for the first 28 weeks of your claim) £68.95 per week
• Short-term higher (paid from weeks 29 to 52 of your claim) £81.60 per week
• Long-term (paid from 52 weeks after your claim*) £91.40 per week.

*If you receive the high rate care component of Disability Living Allowance you will move onto the long-term rate of Incapacity Benefit after 29 weeks rather than 52.

You may be entitled to claim additional amounts of Incapacity Benefit depending on your age and whether you are claiming for a partner.   

Age additions are only paid if you receive the long-term rate of Incapacity Benefit.  If you are aged 35 or under when you first become entitled to Incapacity Benefit, you will be entitled to an extra £15.00 per week after a year when you transfer to the long-term rate of the benefit. If you are aged between 35 and 45 you will be entitled to an extra £5.80 per week after a year.

If you are claiming for an adult dependant (your partner) you can receive the adult dependant addition. Also, if your partner works, their earnings will be taken into account when deciding if you are entitled to an adult addition.  The current adult additions are £41.35 per week for the first 52 weeks of your claim and £53.10 after you have been receiving Incapacity Benefit for a year.

Do I qualify?

To receive Incapacity Benefit you must satisfy all of the following conditions.

• Be aged between 16 and state retirement age. If you are over state retirement age, it is possible to choose to receive short-term Incapacity Benefit rather than claim your pension.
• Be incapable of work.  This is explained in more detail below.
• Have paid enough National Insurance contributions. If you have not you may be entitled to claim Income Support on the grounds of incapacity and this is explained in more detail below.
• Not be receiving Statutory Sick Pay from your employer. If the Statutory Sick Pay you receive from your employer runs out, and you can then claim Incapacity Benefit, your award will usually start at the short-term higher rate of Incapacity Benefit.

What does incapable of work mean?

To be classed as being incapable of work you are initially required to provide a medical certificate from your GP. Medical certificates usually give enough information to pass the first test for incapacity which the Department of Works and Pensions carry out, known as the Own Occupation Test. This looks at your ability to carry out your normal profession and is carried out if you were working prior to claiming Incapacity Benefit.

If you were not working before claiming Incapacity Benefit in addition to providing a medical certificate from your doctor, you may need to undergo the Personal Capabilities Assessment or PCA.  The Department of Works and Pensions (DWP) can consider asking you to take part in the PCA from the start of your claim for Incapacity Benefit.

How does the PCA work?

The government plans to not carry out any more PCAs from February 2011. Instead they will transfer claimants off Incapacity Benefit at around the date when their PCA was due. Claimants will be assessed to see if they can get Employment and Support Allowance instead.

The PCA is a test consisting of two parts, a questionnaire regarding your incapacity (form IB50), followed in some cases by a medical assessment from a DWP approved doctor. Both the questionnaire and the medical consider your ability to complete a variety of physical activities.  In general terms this covers your ability to walk, stand and sit unaided, bend and kneel, pick up objects and lift them, speak, hear and see. There is also an assessment on the questionnaire and in the medical which looks at your mental health and considers your ability to perform a range of non-physical tasks which you may experience problems with. These include your ability to answer a telephone and take a message and concentrate on a television programme. The mental health test also considers if you have any long-term mental health problems and if you become anxious, frightened or irritated in certain situations.

Form IB50 and the medical assessment essentially mirror each other in terms of the questions asked. It is not always the case that you will have a medical examination after you receive an IB50 form as the doctor who looks at the form may consider that you have satisfied the test based on the form alone. It is likely, however, that in many cases a medical examination will be required and this is explained in more detail below.

Both the IB50 form and the medical examination are based on a point scoring system and a minimum amount of points is required to pass the test. Different points are allocated to the difficulty you have in completing each of the physical and mental health tasks, of which there are 18 in total. For example, if you cannot walk for more than 50 metres without feeling severe discomfort, you will score 15 points but if you can walk for 400 metres before feeling severe discomfort you will score just 3 points.

To be classed as incapable of work you need to score a combined total of 15 points if both the physical and mental health tasks are taken together, although if you score 10 points or more on the mental health tasks alone you will also satisfy the test.

Am I exempt from the PCA?

You may receive the IB50 form at any time after your initial claim to Incapacity Benefit is up and running. If you receive form IB50 in the post it is important first of all to consider if you should be considered as exempt from the PCA. If you receive the higher rate Care Component of DLA then you should not have to take part in the PCA and you should inform the DWP of this. The DWP should also consider an exemption from the PCA if you have a severe learning disability or suffer from a severe mental illness and if you feel this applies to yourself, again, you should contact the DWP to inform them. There are a number of physical illnesses which also lead to exemption from the test, though these tend to be progressive, life-threatening illnesses, such as motor neurone disease. If you contact the DWP about this they will be able to inform you further about the exemption categories.

What happens at the medical?

If you are asked to attend a medical it should take place in your local area and you should be given at least seven days notice of it. If you are too ill to attend the medical, you can ask for the doctor to visit you at home, although do not assume that this will be agreed to. You can take a companion with you to the medical examination and you can claim travel expenses for your companion as well as for yourself.

The examination should last about half an hour and the doctor will ask you a series of questions based around the physical and mental health tasks in the IB50 form. They may ask you about a typical day and use your answers to score points in line with the questions on the IB50. For example, if you say you walk to the supermarket then the doctor may use this information to decide your points score for both walking and lifting if you can carry a shopping bag with you when you return.

You may also be asked to complete some physical tasks such as bending or reaching out. It is important that if you can do this but it causes you discomfort to do so then you should mention this to the doctor. Also, if you can manage some of the tasks but only because you are having a good day or you can manage them in that particular environment but not in others this should also be mentioned. Try and explain clearly and in as much detail what your problems are and take along any medication you have been prescribed for your illnesses.

If you fail to attend the medical examination and do not provide a reason for doing so then you will be found capable of work and entitlement to Incapacity Benefit will stop.

If you fail to score the required number of points, you will have been found capable of work, although you do have appeal rights against this. You will normally be paid a reduced amount of Income Support or Jobseekers Allowance while the appeal is being considered.

Income Support or Incapacity Benefit?

If you have not paid the required amount of National Insurance Contributions to receive Incapacity Benefit then it is possible you can claim Income Support based on incapacity instead. To do this requires you to claim both benefits and you must also satisfy the other criteria for receiving Income Support as well. Further information on this can be found on the NAS information sheet Income Support: A guide to calculating and claiming.

If you claim Income Support on the grounds of incapacity and you have not paid enough National Insurance Contributions then you will be awarded a Credits Only Incapacity Benefit award to run in conjunction with your Income Support claim. You will still be expected to provide medical certificates and take part in the PCA as if you received normal Incapacity Benefit. The amount of Income Support paid on the basis of incapacity is usually slightly less than Incapacity Benefit itself.

Incapacity Benefit in youth

If you are under the age 25 it is possible to receive Incapacity Benefit without having paid the relevant National Insurance Contributions. This benefit is known as Incapacity Benefit in Youth or IB(Y) and replaced Severe Disablement Allowance (SDA) which was phased out in 2001. However, some people who were receiving SDA in 2001 remain entitled to it.

To qualify for IB(Y) you need to be between the ages of 16 and 20 although there is an exception to this rule which is explained below. You must also have been incapable of work for a period of 28 weeks before your award starts and you must continue to be incapable of work in the way described above.

The age limit for IB(Y) can be extended to 25 if you have left education but were in full-time education or training three months before your 20th birthday though there are also conditions regarding the date you left . It is important to remember, however, you still need to have been incapable of work for 28 weeks before you can be paid Incapacity Benefit.

Can I work and receive Incapacity Benefit?

As a general rule, as Incapacity Benefit is based on you being incapable of work, you cannot usually work and receive Incapacity Benefit at the same time. There are, however, some exceptions to this rule, and unpaid voluntary work and permitted work are allowed. Permitted work involves work where you earn no more than £20 per week and there is no need for this work to be therapeutic in any way. This is known as the permitted work lower limit. The permitted work higher limit is also allowed and this is work in which you can be employed for no more than 52 weeks working less than 16 hours a week and earning less than £95 per week. Finally, supported permitted work is also allowed.  This is work organised by someone employed by a public authority or by a voluntary organisation who specialise in finding work for people with disabilities. The maximum you can earn in this work is £95 per week also though it should be possible to do this for more than one year. It is advisable to inform the DWP if you are considering starting any type of work.

Anything else?

If you receive State Pension, Jobseekers Allowance, Maternity Allowance, Carers Allowance or Bereavement Benefits you cannot claim Incapacity Benefit as these benefits overlap and cannot be paid together.

Short-term lower Incapacity Benefit is Income Tax free but the short-term higher and long-term rates are both taxable.

If you receive long-term Incapacity Benefit as well as Income Support or Housing Benefit it will entitle you to the disability premium in the calculation of these benefits.

As Incapacity Benefit is a contributory benefit it is not affected by any savings you have. However, if you receive Income Support based on incapacity for work this has a savings limit of £16,000.

You can continue to receive Incapacity Benefit while in hospital.

Finally, The National Autistic Society now has a Welfare Rights Service which can assist with benefit queries.  To book a telephone appointment with a Welfare Rights Adviser call the Autism Helpline on 0845 070 4004 or you can email your query directly to welfarerights@nas.org.uk

Further reading

Greaves, I. (2007). Disability Rights Handbook 32nd edition April 2007 April 2008. London: Disability Alliance.

If you require further information, please contact:

Autism Helpline
Tel: 0845 070 4004 (open 10am-4pm, Monday-Friday)
Minicom: 0845 070 4003
Email: autismhelpline@nas.org.uk 
Website: www.autism.org.uk/helpline

Our Autism Helpline provides impartial, confidential information, advice and support for people with autism spectrum disorders and their families and carers.

Information Centre
Tel: 0845 070 4004 (open 10am-4pm, Monday-Friday)
Fax: +44 (0)20 7833 9666
Email: info@nas.org.uk
Website: www.autism.org.uk/infocentre

Our Information Centre provides a specialist information service for professionals working with people with autism and their families, and students and researchers studying autism.