Income protection and ESA
Comments
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I have to agree that your 'fight' is with the insurance company? Have you made a written complaint? You could include the legislation that has been quoted saying that this payment is counted as income for contribution based ESA.
I do not know whether there is a 'body' that you can escalate your complaint to.
Does anyone know?
To be honest the insurer's website should have information about how to make a complaint (and how to escalate it) so you might want to start there.
Do make sure that you get the complaint in writing so you have evidence of it all.0 -
Your husband became ill ten years ago.
His illness meant that he was unable to work - he was put in the support group so that CB ESA was not time limited.
His employer did not terminate his employment but claimed on an insurance policy (for which the company had paid the premium) and (in effect) paid your husband a reduced salary? This was taxable as income?
Was your husband entitled to ESA in these circumstances?
The employment has now been terminated.
Your husband is now entitled to claim on the policy which should be paying him two thirds of his (pre illness) salary?
This is taxable as income and the tax is taken off by the insurer before payment?
I don't understand how the insurer can deduct an amount in respect of ESA since he is not receiving ESA?0 -
If you meet the qualifying health conditions for ESA you are entitled to contribution based ESA regardless of occupational sick pay received, no matter how much. The change is with pension income which is deducted from the amount payable at the rate of 50% above a disregard of £85/week. He was entitled.Your husband became ill ten years ago. His illness meant that he was unable to work - he was put in the support group so that CB ESA was not time limited.
His employer did not terminate his employment but claimed on an insurance policy (for which the company had paid the premium) and (in effect) paid your husband a reduced salary? This was taxable as income?
Was your husband entitled to ESA in these circumstances?Information I post is for England unless otherwise stated. Some rules may be different in other parts of UK.0 -
Hi
Yes I have wrote to insurance company with a few issues as I also discovered he had been getting paid £1k short a year. This all stems from us not being allowed a copy of the policy details. The company were helpful at the time but said it belonged to them, I eventually got my husband's union involved which felt quite awkward at the time but I had no choice. They eventually sent a page of the policy. A few years ago they relented given that there were some issues that I had, namely the ESA and the fact he was paid short. I wrote to the Ombudsman who were helpful and ensured that he was given back pay for the money he was short (a typing error apparently) but there was nothing that they could do regarding the ESA as the policy documents state that you do not always receive ESA but it is deducted. The Ombudsman did rule that as this is stated in their T & C's then there is nothing we can do. I challenged the employer and the broker on this but they advised the same. I have recently written to the Ombudsman regarding the broker and they did try to stop me doing this citing that my husband is not the customer as the employer is (the amount of resistance I have had over the years trying to sort these issues out is incredible). The Ombudsman did tell them it fell under their jurisdiction but the end result was that they felt it was more a DWP issue than the broker as he didn't feel they were responsible for the impact the arrangement had on my husbands benefits. Xylophone you are exactly right, that is the policy he has, two thirds of his salary (which they initially did not pay and I had to go through the ombudsman again to fight this successfully even though his employer challenged it initially and did not resolve) and that is how we feel, why deduct if he doesn't get it. Apparently they can write this into the terms and conditions (the one's he was not allowed to see for 10 years) and be perfectly legal. On top of this he was incapacitated for a great deal of time, he struggles to understand the details even now and I had a baby and a toddler to look after hence why it has taken so long to try and comprehend how I can fight this. Every avenue I go down i'm blocked with legal jargon saying that they are within their rights. Something just doesn't feel right about the whole situation. Thanks for all of your replies.0 -
Can you print out exactly what the terms and conditions are relating to the ESA?0
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It does seem grossly unfair that a deduction can be made for a benefit which cannot be paid under benefit rules. However I think that if OP has already been to ombudsman it is unlikely that users of this forum are going to come up with a solution.Information I post is for England unless otherwise stated. Some rules may be different in other parts of UK.0
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the policy documents state that you do not always receive ESA but it is deducted
Calcotti has clarified that while your husband was employed, the money he received through the company (albeit claimed by the company from the insurance policy for which the company paid) counted as "occupational sick pay" and therefore he was entitled to ESA and indeed he received it.
Presumably this "sick pay" was taxable and any tax due was deducted before he received the payment.
The company has terminated his employment. He is no longer receiving "occupational sick pay".
This is a PHI policy the premium for which was always paid by the company.
Now that your husband is claiming on the policy, because he did not pay 50% of the premium, legislation requires that the payment made by the insurance company should be treated as though it were a pension.
Is it the case that under these circumstances he is no longer entitled to CB ESA and family income dictates that he is not entitled to IR ESA?
Despite the fact that he is not entitled to receive any type of ESA, the terms of the policy state that the Insurance Company is entitled to deduct the full amount of CB (IR?) ESA from the payment due to your husband (as well as any tax due)?
If this is the case then your husband has to accept it?0 -
I find it interesting that the ombudsman said that it was more a DWP issue than the insurance company's.
I would still be interested to know what the exact wording was. The OP states that the insurance company stated that '' they have the right to deduct ESA even though he doesn't get it back.''
Is this written into the terms and conditions or was it something that someone at the insurance company said?
Two thoughts. Since the OP's husband was being paid contribution based ESA whilst still in employment was the insurance company informed that this came to an end when the husband finished employment?
Is it worth going back to the ombudsman with the ESA award letter showing that he is not receiving any ESA due to the deduction of the PHI plus writing out the legislation regarding this?
At the very least I would have thought that this was an unfair term in the contract if it says the ESA is deducted regardless of whether the ESA is in payment0 -
pmlindyloo wrote: »At the very least I would have thought that this was an unfair term in the contract if it says the ESA is deducted regardless of whether the ESA is in payment
That struck me too.Information I post is for England unless otherwise stated. Some rules may be different in other parts of UK.0 -
Is it worth going back to the ombudsman with the ESA award letter showing that he is not receiving any ESA due to the deduction of the PHI plus writing out the legislation regarding this?
Is that the reason?
Is the case that having had his employment terminated he is no longer entitled to CB ESA only IR ESA and the family means preclude his receiving this?
Otherwise, he would be entitled to the ESA but any amount over £85 would be subject to a 50% deduction?
It appears that he is not entitled to ESA of any description but regardless of this, the policy terms permit the insurance company to deduct an amount in respect of full(?) CB ESA.
The Ombudsman appears to have ruled that the insurer has the right to set the terms of the policy.
How is it a DWP issue? Do you think he should be entitled to ESA of some description?0
This discussion has been closed.
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