Employment Support Allowance & Permanent Health Insurance

Bentley_Boys_UK · 7 January 2009 at 6:41PM

I'm trying to get a definitive answer on the following, can anyone help ?

I'm currently off sick and put a claim in for ESA on 1/12/08. My employers provide a Permanent Health Insurance scheme (via BUPA) which guarantees a % of my income until retirement (or return to work). After a long process I was finally successful in my claim for the PHI but I'm currently getting mixed messages from Job Centre Plus on the ESA claim.

The PHI is paid (% of income - rate of ESA) on the assumption ESA will be paid. I satisfy all other criteria for ESA(contribution) e.g. NI contributions, sick note etc. but have received a letter today from Job Centre Plus saying that I would not qualify for ESA due to the PHI counting as income.

I've spoke to a number of people in Job Centre plus today and have conflicting messages i.e. PHI does / does not count as income. I also have found some guidance which states it is ignored if PHI is being paid by an employer and the contract of employment is still in place. My employer and Bupa also support the does not count stance.

Anyone got any experience of this?

COUPON_GIRL · 7 January 2009 at 7:42PM

Yes, the reason PHI is less Incapacity Benefit is that you are expected to claim both. I have been claiming both for the past 3 years now. The job centre are fully aware of the PHI. I have met other people, through my disability, who also claim both. Hope this helps.:o

Bentley_Boys_UK · 7 January 2009 at 8:03PM

Many Thanks, I thought that had to be the case as Bupa clearly stated in their acceptance letter that the PHI claim would be less Incapacity. I'm just getting mixed messages from JC+. I declared my entitlement to the PHI on application for ESA and had it confirmed then that it would not effect my claim (subject to all other conditions being correct), but today I've spoken to three different people each with differing views in JC+ and await a call back tomorrow.

COUPON_GIRL · 7 January 2009 at 8:35PM

Bentley_Boys_UK wrote: »

Many Thanks, I thought that had to be the case as Bupa clearly stated in their acceptance letter that the PHI claim would be less Incapacity. I'm just getting mixed messages from JC+. I declared my entitlement to the PHI on application for ESA and had it confirmed then that it would not effect my claim (subject to all other conditions being correct), but today I've spoken to three different people each with differing views in JC+ and await a call back tomorrow.

Hopefully once they have been around the houses a bit, they will come up with the right result. Good luck, let me know how you get on.

Bentley_Boys_UK · 8 January 2009 at 6:08PM

Just a quick update. My case handler called back today and confirmed that PHI income is not counted in the assessment of ESA (Incapacity Benefit) claims. He apologised for the error and my claim is now back with the decision maker who hopefully will make an award.

In fact he also said that they had made a mess of my whole claim. It had been treated as income and not contribution based ESA as it should have been and the initial advice I received to make a claim for ESA (for the period from 27th October) and a separate claim for Incapacity Benefit (retrospective to 27th October) was incorrect. I think it is now being treated as one claim.

Thank you Coupon Girl for giving me a real life example of the way I thought it worked. I was told twice yesterday that I was wrong and my claim was correctly rejected. At one point I had convinced myself to give up and that the ruling was correct. I also took some advice last night from an independent helpline - thanks Robin (if you are part of these forums) for looking into the regulations and guidance for me.

tom9980 · 8 January 2009 at 6:14PM

Thanks for the update nice to hear the system caught up in the end.

COUPON_GIRL · 8 January 2009 at 9:45PM

Bentley_Boys_UK wrote: »

Just a quick update. My case handler called back today and confirmed that PHI income is not counted in the assessment of ESA (Incapacity Benefit) claims. He apologised for the error and my claim is now back with the decision maker who hopefully will make an award.

In fact he also said that they had made a mess of my whole claim. It had been treated as income and not contribution based ESA as it should have been and the initial advice I received to make a claim for ESA (for the period from 27th October) and a separate claim for Incapacity Benefit (retrospective to 27th October) was incorrect. I think it is now being treated as one claim.

Thank you Coupon Girl for giving me a real life example of the way I thought it worked. I was told twice yesterday that I was wrong and my claim was correctly rejected. At one point I had convinced myself to give up and that the ruling was correct. I also took some advice last night from an independent helpline - thanks Robin (if you are part of these forums) for looking into the regulations and guidance for me.

Great news, the last thing you need is a battle when your not feeling your best. Good luck with the future.

Coupon Girl

Employment Support Allowance & Permanent Health Insurance

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