Claiming health benefits

If you're sick or disabled and it’s affecting your ability to work, you may be entitled to health benefits. Find out what’s on offer and how to claim.

Jump to section:

1. Statutory Sick Pay (SSP)
2. Employment and Support Allowance (ESA)
3. Disability Living Allowance (DLA) and Personal Independence Payments (PIPs)
4. Industrial Injuries Disablement Benefit
5. My health benefits claim was rejected – what can I do?
6. Does Universal Credit affect health benefits?
7. Where can I go for help with health benefits?

Who can claim health benefits?

There are so many different health-related benefits and tax credits available it can be hard working out what you’re entitled to.

But if you have mental or physical health problems that limit your ability to work, or make you unable to work, then there are different types of benefits suited to different people’s situations. Here, we list the main ones and indicate what you might be entitled to for each.

Statutory Sick Pay (SSP)

Everyone needs time away from work sometimes, especially if you’ve been taken ill through no fault of your own. You might be worried that being ill will affect your ability to earn, however Statutory Sick Pay exists to help make sure that you have some form of income whilst you can’t work.

Who qualifies for Statutory Sick Pay?

If you cannot do your job because you’re sick or disabled, you may qualify for Statutory Sick Pay (SSP). You need to have been earning £120 or more a week, and will need to provide ‘fit notes’ (what used to be called sick notes) after seven days. (Other rules also apply.)

How can I claim Statutory Sick Pay?

If you’re unwell, it’s likely that you’ve already told your employer that you won’t be able to work – it is your employer that pays your SSP. They’ll have their own rules as to how you should inform them of your illness, and a time limit for how long you can be off without a note from a doctor to confirm. It’s best to check with the appropriate person (your manager, HR department etc) as soon as you become sick.

How much statutory sick pay will I get?

You can get paid £96.35 for up to 28 weeks off sick (after that, you may be able to claim Employment Support Allowance – see below). Once you’ve been off for four consecutive days, then you’ll be entitled to sick pay.

Find out more: See our Sick Pay article.

Employment and Support Allowance (ESA)

Sometimes, an illness is not short lived, which can make it very difficult for you to work beyond the 28 weeks that you can get Statutory Sick Pay for. This is where Employment Support Allowance can help you. It exists as financial support for long term illnesses or disabilities that mean you are unable to earn.

Who qualifies for Employment and Support Allowance?

You need to be either unable to work or very limited due to sickness or disability. This may mean numerous visits to your doctor to be able to prove your illness or disability makes it impossible for you to work. This is known as a Work Capability Assessment, which is likely to happen within the first 13 weeks of your ESA claim.

ESA is slowly being replaced by Universal Credit, however you may still be able to claim it if you already do in some capacity, or if you or your partner were receiving contribution-based ESA before Universal Credit came into effect.

How much Employment and Support Allowance will I get?

There are two types of Employment and Support Allowance – income-based and contributory ESA. They’re measured in different ways, but to give an indication:

• Income-based is measured based on age, living situation, household income, whether or not you’ve had a Work Capability Assessment, along several other factors.
• Contributory is worked out by factoring your age, whether you’ve had the Work Capability Assessment (and the outcome of this, whether you’re in the activity or support group)

As a guide, a single person under the age of 25 with no income or savings could receive £59.20 a week for the first 13 weeks. After you’ve had your Work Capability Assessment, it’s likely that this amount will increase to around £74.70 if you’re deemed to be in the Work-Related Activity Group, or £114.10 if you’re put into the Support Group.

Find out more: See Employment and Support Allowance (ESA)

Disability Living Allowance (DLA) and Personal Independence Payments (PIPs)

DLA is gradually being replaced by PIP. If you get DLA, then you’ll be moved to PIP at some point in the next few years. You can find out when the changes will affect you using this tool.

Who qualifies for Disability Living Allowance and PIP?

If you have a long-term health problem or disability that affects your ability to care for yourself or to work, then you might be able to get PIP. It can mean that you’re able to buy food, pay your rent, and even help with purchasing an adapted Motability car if you need it to get around and you’re having mobility issues.

To be able to access PIP, you’ll need to be assessed by a health professional to prove your inability to work.

How much will I get on Disability Living Allowance?

When you apply for Personal Independence Payments, the amount you’ll receive will be based on two parts – daily living (care) and mobility. The amount you’ll get from each depends on how severe your condition is thought to be, and how much it impacts your life. To give you a rough idea:

• The weekly rate for the daily living part of PIP is either £60.00 or £89.60
• The weekly rate for the mobility part of PIP is either £23.70 or £62.55

PIP doesn’t count as income, which means you’re still entitled to other income-related benefits.

How can I claim Personal Independence Payments

If you’re starting a new claim for PIP, you’ll need to call the Department for Work and Pensions. They’ll be able to talk you through the process, and tell you what you’ll need to do to be able to claim this benefit. When you call them, you’ll need to give them some information about yourself, including your National Insurance number.

PIP is usually paid every 4 weeks – when you get your decision letter through the post, it will tell you when to expect your first payment, and what day of the week you’ll usually be paid.

Find out more: Read more on PIP from the GOV.uk website. You can also contact the PIP helpline on 0345 850 3322, or Textphone 0345 601 6677.

Industrial Injuries Disablement Benefit

Industrial Injuries Disablement Benefit is a very specific type of benefit awarded to people who have had an accident at work that has then meant that they’re unable to do their job.

Who qualifies for Industrial Injuries Disablement Benefit?

If you are disabled due to suffering an industrial injury or disease at work, you could be entitled to industrial injuries disablement benefit. You can apply at any age, as long as you have a contract of employment for the work you were doing at the time – you wouldn’t be able to claim this benefit if you were, say, self-employed.

How much Industrial Injuries Disablement Benefit will I get?

The amount of Industrial Injuries Disablement benefit you’re entitled to is calculated on a number of factors, such as how serious your injury is and to what extent this had led to you becoming disabled, and also your age. For example, if you’re 100% disabled as a result of your accident, it’s likely that you’ll be paid a higher amount.

There are many payment rates; depending on your circumstances you can get up to a maximum of £182.90 a week. And depending on the impact that the accident has had on your life, you could be paid this benefit for either a short period of time, or for life.

Find out more: GOV.UK

My health benefits claim was rejected – what can I do?

You can always get advice on what benefits you might be entitled to, as well as help with applying and challenging decisions, from your local Citizens Advice Bureau (CAB).

If your benefits claim is rejected, try not to panic. There are processes in place to help you – you have the right to ask for the DWP to look at the decision again. This is called a mandatory reconsideration and you have one month from the date of the decision to ask for this. If you are still not happy with the reconsidered decision you can appeal to an independent tribunal within a month of the reconsidered decision. You have a higher chance of succeeding if you get advice from your local CAB.

You can read more about challenging decisions from our article on Benefits Appeals.

Does Universal Credit affect health benefits?

Universal Credit is gradually being rolled out over the UK, and will replace:

• Income-based JSA
• Income-related ESA
• Income Support
• Child Tax Credit
• Working Tax Credit
• Housing Benefit

Contribution-based ESA, PIP, and Statutory Sick Pay won’t be affected.

Find out more: See our Universal Credit article.

Where can I go for help with health benefits?

Getting benefits is often a frustrating process. But there are lots of places you can go for help:

• Citizen’s Advice know all about the benefits system and can help you understand your rights. You can visit your local bureau to get face-to-face advice and support. You must remember to bring along details of your benefits and general financial situation.
• This benefits calculator from Turn2us shows you how much benefit you should be getting – many people don’t realise how much they’re entitled to.
• If you want to challenge a decision about your benefit, you can appeal.

Unfortunately we are unable to offer benefits advice at The Mix, but we can give emotional support and guide you to the best places for expert advice if you give us a call on 0808 808 4994

Remember to tell your benefits advisor if your circumstances change – for example, if you get a pay rise, new job or get married. If you don’t you could face a £50 fine, as well as having to pay back any extra benefit. See GOV.UK for more information.