Applicants whose NHS employment ceases on or before 30 March 2018 need to make their application on form AW13, which is available from employers. Part of the form is completed by the employer and part of it by the applicant.
Whilst employers can express an opinion as to an individual’s entitlement to PIB they cannot deny an individual’s right to apply for PIB.
Applications can be completed whilst an employee is still employed, but the outcome cannot normally be decided until they have left their NHS employment or moved to a permanent lower paid job.
In the course of a PIB application the employee must provide the Scheme administrators with the following information:
- the injuries sustained or the disease contracted (i.e. the condition), its treatment and prognosis
- how it is connected to their NHS employment or duties (i.e. what caused it)
- how or whether the injury or disease has caused a permanent reduction in earning ability.
With the PIB application form, employers must include copies of:
- all accident reports
- all Occupational Health Department notes and records
- reports of any internal investigation connected with the claim
- a full job description
- sick leave records
- a full statement of events explaining what injury/disease the applicant is claiming for and the circumstances leading to the claim. Employers who do not support the claim must still provide a statement, and whatever other information the Scheme administrators require to process the claim.
Applicants are required to provide, on the application form, a statement explaining the details of the injury sustained or disease contracted and its effect on their ability to work and carry out daily activities. They are asked to check the information provided on the form by their employer and any other accompanying documentation, and to provide copies of all documents or reports in their possession that relate to their application. These might include accident book records, DWP accident declarations or medical assessment papers, witness statements, GP or hospital records, compensation claims and any other evidence they think might be useful in supporting their application.
The Permanent Injury Benefit claims process
The application form and supporting material will be passed to the Scheme’s medical advisers who will assess the existence and effect of the injury or disease on the applicant’s work. During this process the applicant may be asked for additional information/evidence which may include examination by an independent medical expert or functional analyst.
If it is accepted that the applicant has suffered an injury or disease wholly or mainly attributable to their NHS duties or employment, an assessment of the degree of ‘permanent loss of earning ability’ (PLOEA) will be made, which in turn will determine the level of benefit if any payable. If the PLOEA is 10% or less, PIB will not be payable. This does NOT mean PIB will never be payable; if the applicant’s injury or disease deteriorates further and with it their permanent reduction in earning ability, they can contact the Scheme administrators for a review of their application.
Determining the PLOEA involves looking at the applicant’s earnings when the employment ended or when the applicant moved to permanent lower paid NHS employment and then assessing their permanent reduction in earnings ability as a result of the injury or disease. The Scheme’s medical advisers will consider the applicant’s capability for work in the general field of employment.
If the application for PIB has progressed to the stage where a permanent loss of earning ability has been established, the Scheme administrators will then work out the PIB annual allowance applicable to their case. How they do this is explained under Permanent Injury Benefits (PIB) payable.
Any payments awarded will usually be backdated to the start of the permanent reduction in earnings ability. For those who remain in NHS employment on permanent lower pay it will usually be from the start of the permanent lower pay. For those who terminate their employment, it will be from the day after the termination of employment.
Forms and guidance notes