How does ESA work if you are still employed but off sick?

chivers1977

Am I right in thinking that:

-I can apply from when my SSP runs out at 28 weeks,
-then they will pay me the assessment rate for 13 weeks
-If I don't pass the medical that the payments will then stop as I can't claim JSA as still employed?

I am now at 26 weeks off sick at the moment and now waiting for an angiogram to see if they can finally find out what is wrong with me, following 3 x MRI, xrays, A&E visit in ambulance, cortisone and EMG tests.

stazi

Your employer should have already given you form SSP1 to say that SSP will end at week 28. Then claim ESA from week 29 ASAP by calling JCP on 0800 055 6688.

chivers1977

Thanks Stazi. I work for one of the biggest employers in the country and apparently I have to wait until after the 2nd June when my 28 weeks runs out and then they will do the SSP. I have argued and argued but apparently this is the way that it is done..... will call again this morning

MrsManda

They really ought to give you the SSP1 form as soon as possible - as they know when your SSP is going to run out there's no reason why they cannot fill it out now. The forms are easily available to you if you think it's worth printing one off and getting a manager to fill it in.

http://www.direct.gov.uk/en/MoneyTaxAndBenefits/BenefitsTaxCreditsAndOtherSupport/Illorinjured/DG_10018786

As for the rest of your questions; you'll claim ESA and receive the assessment rate while they sort out your claim. This is paid for a maximum of 13 weeks then you should go onto the assessed rate which depends on which group you are put in. You can receive the assessed rate eariler, it depends on when you have a medical/they decide on your grouping.

If you are found fit for work you can appeal which I think means that you continue to receive the assessment rate while the appeal process goes on. The money will stop if you are found fit for work but you'll be advised what you can claim instead.

If you receive contributions based ESA and are put into WRAG then you can claim this for upto 12 months then you will be assessed for income based ESA which will take into consideration your household income. If you're placed in the Support Group this 12 month limit doesn't apply.

Hopefully you'll be back on your feet soon so all this comes irrelevant and you can go back to work.

chivers1977

Thank you Mrs Manda. I have called HR today and asked read out from the HMRC website to them where it says that they can do it from the 23rd week of sickness. Surprisingly enough they are going to now send me one!

Thanks for the info re what happens next. I have never had to claim anything before and it is such a huge shock going from full pay down to SSP, let alone ESA....... I really want to get back to work but the lack of getting a diagnosis and treatment is holding me back at the mo. At least I know that I can appeal if need be.

pinklady21

Sorry to hear about your illness - I know how much of a shock it is suddenly being unable to work!
As your employer is quite a large one - do they have any arrangements in place for Permanent Health Insurance?
Some employers offer this as part of their employment contract with you, they take out a group policy that covers all or some of their employees.
It might be worth asking your employer if this applies to you.
Best of luck

chivers1977

Thanks Pinklady. We actually do have Income Protection through work but as I kept thinking I would get better in time, I didn't apply early enough. It should be processed by July/August apparently and will pay 50% of my salary minus territorial allowance. However it is all subject to the claim being authorised by the insurer so am looking at worst case scenario at the moment

pinklady21

Check if they can backdate it - if it is a Group Policy it will probably be the HR dept who administer it - you want the Income Protection claim to start from when your SSP / company sick pay runs out.

It may be that the PHI claim will take a while for the insurer to process, and they may ask for medical evidence. Have you been seen by the Occupational Health Doctor? They could also provide a report.
Be aware that sometimes these policies also deduct an amount for State Benefits ie ESA, whether or not you actually receive it, so you should probably continue with the ESA claim anyway.

Also - watch out for the insurance company 'tricks'. Do not under any circumstances allow them to visit you at home, for instance. This is not designed to be helpful to you, but to them. They may try and use such a visit to gather information against you and use it to refute the claim.

Sorry to seem gloomy, but you have to act in your own best interests in this situation. I hope it all works out for you.

NASA_2

Just to correct something said above, you do not receive the 'assessed rate' earlier if your medical is done and dusted before the 13 week point. It will still take effect from the end of the 13th week.

People who have less than six months to live are fastracked to the main phase rate but that is without a medical so long as they have supplied a DS1500.

chivers1977

So far my GP has been written to to request a report but I haven't been called for an OH medical yet - will bear in mind not to let them into my home. They will backdate to the 26th week of absence if it gets agreed. My policy will cover me for 50% of my salary plus ESA so long as the total doesnt exceed 75% of my salary (which it won't).

Thanks for your advice, I had no idea that they might try and trick me out of the claim payout.

pinklady21

I am afraid the PHI insurers are absolutely ruthless. They are businesses set up to make a profit, not caring organisations there to look after you!
It is the last thing you need when you are already unwell.

Suggest you also ask to see the actual insurance policy, as well as your Firm's sickness absence policy too if you don't already have it - your HR dept should be able to help there.

I sincerely hope it all works out. Best of luck.